Healthcare Provider Details

I. General information

NPI: 1376175083
Provider Name (Legal Business Name): FLORENTINA ISABELE VULCAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 09/27/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MIDDLETON RD
NAMPA ID
83651
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2800
  • Fax: 208-505-2801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number63852
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: