MEDICARE: MS. JO ANN CULLEN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9186216	FL
2	363L00000X	Nurse Practitioner	20192	SC

General Provider Information

NPI Number	:	1376823864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JO ANN CULLEN ARNP

Provider Business Mailing Address
First Line	:	26 PEBBLEBROOK CT
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-1935
Country	:	US
Telephone Number	:	813-334-9996
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 MALLETT WAY
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-6064
Country	:	US
Telephone Number	:	843-815-6699
Fax Number	:	843-815-6695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2011
Last Update Date	:	04/24/2019

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