Provider Demographics
NPI:1932191681
Name:ABBOTT, CAROL JEAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:ABBOTT
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 1:5885 HARRISON AVE
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1691
Mailing Address - Country:US
Mailing Address - Phone:513-922-9660
Mailing Address - Fax:
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1691
Practice Address - Country:US
Practice Address - Phone:513-922-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY363FL0000XMedicaid
OH2291265Medicaid
OHP01972Medicare UPIN