Healthcare Provider Details

I. General information

NPI: 1275619850
Provider Name (Legal Business Name): DEBORAH CARTER FULOP ARNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD SUITE 4090
JACKSONVILLE FL
32216-1471
US

IV. Provider business mailing address

2257 SAYE DR E
JACKSONVILLE FL
32225-4862
US

V. Phone/Fax

Practice location:
  • Phone: 904-393-7910
  • Fax:
Mailing address:
  • Phone: 904-646-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1519592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: