Healthcare Provider Details

I. General information

NPI: 1497673602
Provider Name (Legal Business Name): KIERAN TULLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N 21ST AVE
HOLLYWOOD FL
33020-4537
US

IV. Provider business mailing address

9952 ROBINS NEST RD
BOCA RATON FL
33496-2101
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-3000
  • Fax:
Mailing address:
  • Phone: 561-909-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9506488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: