Provider Demographics
NPI:1336691815
Name:YACULA, CAROL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:YACULA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-645-3499
Mailing Address - Fax:
Practice Address - Street 1:100 SILICATO PKWY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1271
Practice Address - Country:US
Practice Address - Phone:302-703-3595
Practice Address - Fax:833-629-0784
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10019605363LG0600X
MO2016017862363LA2200X
DELP-0010758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health