Provider Demographics
NPI:1053734095
Name:FALLUCCA, KARLA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:FALLUCCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 YORKSHIP SQ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-2865
Mailing Address - Country:US
Mailing Address - Phone:856-541-5588
Mailing Address - Fax:856-338-9223
Practice Address - Street 1:2961 YORKSHIP SQ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-2865
Practice Address - Country:US
Practice Address - Phone:856-541-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00479100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily