Provider Demographics
NPI:1134501877
Name:KOVACH ROMERO, CARLI J (NP-C)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:J
Last Name:KOVACH ROMERO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14121 PARKE LONG COURT, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1647
Mailing Address - Country:US
Mailing Address - Phone:855-247-1940
Mailing Address - Fax:
Practice Address - Street 1:7345 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8654
Practice Address - Country:US
Practice Address - Phone:614-794-5560
Practice Address - Fax:614-839-0274
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.17465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139641Medicaid