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NPI Code Detail

MEDICARE: MRS. TENIKQUA FULLWOOD-MAPLE PMHNP-BC

MEDICARE: MRS. TENIKQUA FULLWOOD-MAPLE PMHNP-BC
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
1363L00000XNurse Practitioner31415SC

General Provider Information

NPI Number : 1932059888
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TENIKQUA FULLWOOD-MAPLE PMHNP-BC
Provider Business Mailing Address
First Line : 2733 SANDHILL DR
Second Line :
City : SUMTER
State : SC
Zip : 29154-5316
Country : US
Telephone Number : 803-774-4500
Fax Number :
Provider Business Practice Location Address
First Line : 1278 N LAFAYETTE DR
Second Line :
City : SUMTER
State : SC
Zip : 29150-2964
Country : US
Telephone Number : 803-774-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2026
Last Update Date : 01/30/2026

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Directions to “ MRS. TENIKQUA FULLWOOD-MAPLE PMHNP-BC” Practice Location

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