Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Johanna Derisca

Individual provider Acute Care Nurse Practitioner · NPI 1205639895

Johanna Derisca is a Nurse Practitioner in New York, New York. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2025

Practice location Address checks out

506 Lenox Ave
New York, NY 10037-1802
Phone: (844) 692-4692
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 432908 (NY)

Record details

NPI number1205639895
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 29, 2025
Last updated in NPPESMarch 29, 2025
Certification dateMarch 29, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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