Healthcare Provider Details

I. General information

NPI: 1164388203
Provider Name (Legal Business Name): JOVELIA ANTONIO REPULLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MERCHANT ST STE 2900
HONOLULU HI
96813-4384
US

IV. Provider business mailing address

94-1080 LUMIPOLU ST
WAIPAHU HI
96797-3954
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-8012
  • Fax: 727-592-5395
Mailing address:
  • Phone:
  • Fax: 727-592-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-5648
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: