Basic Information
| Provider Information | |||||||||
| NPI: | 1548645278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLACRUCIS | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | TORRES | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 7TH AVE FL 12 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100016756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126041730 | ||||||||
| FaxNumber: | 2126041750 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 7TH AVE FL 12 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100016756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126041730 | ||||||||
| FaxNumber: | 2126041750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F339481-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 04661932 | 05 | NY | MEDICAID |