Healthcare Provider Details

I. General information

NPI: 1356721179
Provider Name (Legal Business Name): SARAH L FULAYTAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD
MIAMI FL
33132-1449
US

IV. Provider business mailing address

20 BLANDING BLVD
ORANGE PARK FL
32073-2202
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-0323
  • Fax: 866-427-3798
Mailing address:
  • Phone: 904-773-8977
  • Fax: 904-773-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN248833
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19515
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: