Provider Demographics
NPI:1871199679
Name:PUATU, SHERISSE SOFIA (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHERISSE SOFIA
Middle Name:
Last Name:PUATU
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 CANTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2020
Mailing Address - Country:US
Mailing Address - Phone:562-413-6086
Mailing Address - Fax:
Practice Address - Street 1:1617 WESTCLIFF DR STE 205
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5526
Practice Address - Country:US
Practice Address - Phone:949-432-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner