Provider Demographics
NPI:1588369599
Name:SULCA, JOHANNA DELMIRA (FNP)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:DELMIRA
Last Name:SULCA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6371 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2714
Mailing Address - Country:US
Mailing Address - Phone:518-379-7991
Mailing Address - Fax:
Practice Address - Street 1:1685-SR-7 N
Practice Address - Street 2:UNIT 4
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023
Practice Address - Country:US
Practice Address - Phone:954-397-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily