Provider Demographics
NPI:1376133843
Name:TARABORELLI-BAXTER, CAROLYN (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TARABORELLI-BAXTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5719
Mailing Address - Country:US
Mailing Address - Phone:401-415-4618
Mailing Address - Fax:401-415-4348
Practice Address - Street 1:1085 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5719
Practice Address - Country:US
Practice Address - Phone:401-415-4618
Practice Address - Fax:401-415-4348
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN46584163W00000X
RIAPRN02511363L00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology