Healthcare Provider Details

I. General information

NPI: 1093366528
Provider Name (Legal Business Name): JHOANNA ZULUAGA OLAVE AGACNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST FL 15
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

15 SPENCER DR
NEW ROCHELLE NY
10801-3045
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6037
  • Fax:
Mailing address:
  • Phone: 917-607-2237
  • Fax: 212-342-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408968
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF431479
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: