Provider Demographics
NPI:1073279030
Name:ROURKE, CARLY ESTRELLA (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:ESTRELLA
Last Name:ROURKE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MS
Other - First Name:CARLY
Other - Middle Name:ESTRELLA
Other - Last Name:COEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, AGACNP-BC
Mailing Address - Street 1:5369 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2809
Mailing Address - Country:US
Mailing Address - Phone:513-903-0341
Mailing Address - Fax:
Practice Address - Street 1:7675 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2509
Practice Address - Country:US
Practice Address - Phone:513-475-8521
Practice Address - Fax:513-475-7480
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029781363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care