Healthcare Provider Details

I. General information

NPI: 1013530195
Provider Name (Legal Business Name): SALMA GOZUSULU ARNP, FNP, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BRAZILIAN AVE
PALM BEACH FL
33480-4621
US

IV. Provider business mailing address

PO BOX 332
PALM BEACH FL
33480-0332
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-0739
  • Fax:
Mailing address:
  • Phone: 561-955-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9999991
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9999999
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number363LP2300X
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number2083C0008X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: