Healthcare Provider Details

I. General information

NPI: 1336691815
Provider Name (Legal Business Name): CAROL YACULA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SILICATO PKWY
MILFORD DE
19963-1271
US

IV. Provider business mailing address

1515 SAVANNAH RD
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-3595
  • Fax: 833-629-0784
Mailing address:
  • Phone: 302-645-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10019605
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2016017862
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010758
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: