Provider Demographics
NPI:1053965848
Name:ULETT, JOHANNA S
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:S
Last Name:ULETT
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 1:3800 INVERRARY BLVD STE 100O
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4316
Mailing Address - Country:US
Mailing Address - Phone:954-638-4572
Mailing Address - Fax:954-634-5699
Practice Address - Street 1:3800 INVERRARY BLVD STE 100O
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4316
Practice Address - Country:US
Practice Address - Phone:954-638-4572
Practice Address - Fax:954-634-5699
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30212051251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health