Healthcare Provider Details

I. General information

NPI: 1861714644
Provider Name (Legal Business Name): DESIREE SOKOLI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 W ONTARIO ST
PHILADELPHIA PA
19140-5220
US

IV. Provider business mailing address

3500 N BROAD ST RM 1A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2400
  • Fax: 215-707-4034
Mailing address:
  • Phone: 215-926-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number26NJ00279600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028692
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: