Provider Demographics
NPI:1275502908
Name:GULOTTA, NANCY A (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:GULOTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10251 W COMMERCIAL BLVD
Mailing Address - Street 2:C136
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10251 W COMMERCIAL BLVD
Practice Address - Street 2:C136
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4326
Practice Address - Country:US
Practice Address - Phone:954-580-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2084322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305660100Medicaid
FL305660100Medicaid
FLE4331XMedicare ID - Type Unspecified
P09856Medicare UPIN
FLE4331VMedicare ID - Type Unspecified