Healthcare Provider Details

I. General information

NPI: 1083208466
Provider Name (Legal Business Name): VALENTINA ANN GOULARTE AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST
BALTIMORE MD
21287-0019
US

IV. Provider business mailing address

1004 S CURLEY ST
BALTIMORE MD
21224-4826
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8964
  • Fax:
Mailing address:
  • Phone: 360-930-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number60315102
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR247226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: