Healthcare Provider Details

I. General information

NPI: 1528639317
Provider Name (Legal Business Name): JENNIFER FULLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ROSS COMPTIS MD

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1898
US

IV. Provider business mailing address

2261 SW 84TH WAY
MIRAMAR FL
33025-5134
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax: 305-703-0762
Mailing address:
  • Phone: 786-498-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR81100
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number20-362
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: