Provider Demographics
NPI:1548645278
Name:VILLACRUCIS, JOAN TORRES (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JOAN
Middle Name:TORRES
Last Name:VILLACRUCIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 7TH AVE FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6756
Mailing Address - Country:US
Mailing Address - Phone:212-604-1730
Mailing Address - Fax:212-604-1750
Practice Address - Street 1:275 7TH AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6756
Practice Address - Country:US
Practice Address - Phone:212-604-1730
Practice Address - Fax:212-604-1750
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339481-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04661932Medicaid