Basic Information
| Provider Information | |||||||||
| NPI: | 1275502908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GULOTTA | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | ARNP | ||||||||
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| OtherLastName: | GULOTTA | ||||||||
| OtherFirstName: | NANCY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10251 W COMMERCIAL BLVD | ||||||||
| Address2: | C136 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333514326 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10251 W COMMERCIAL BLVD | ||||||||
| Address2: | C136 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333514326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545804100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP2084322 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 305660100 | 05 | FL | MEDICAID |