Provider Demographics
NPI:1073268249
Name:TEPSICK, CARLY RAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:RAE
Last Name:TEPSICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3358
Mailing Address - Country:US
Mailing Address - Phone:330-726-3204
Mailing Address - Fax:330-729-9316
Practice Address - Street 1:715 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3358
Practice Address - Country:US
Practice Address - Phone:330-726-3204
Practice Address - Fax:330-729-9316
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030759207RC0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease