Provider Demographics
NPI:1174043731
Name:DE LAROSA, GIAVANNA N (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:GIAVANNA
Middle Name:N
Last Name:DE LAROSA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:GIAVANNA
Other - Middle Name:N
Other - Last Name:DE LAROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4448
Mailing Address - Fax:614-293-3277
Practice Address - Street 1:300 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-4448
Practice Address - Fax:614-293-3277
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244680Medicaid