Healthcare Provider Details

I. General information

NPI: 1346158037
Provider Name (Legal Business Name): ANNETTE FULLERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 SW 52ND TER
OCALA FL
34474-9483
US

IV. Provider business mailing address

3630 SW 52ND TER
OCALA FL
34474-9483
US

V. Phone/Fax

Practice location:
  • Phone: 347-706-9320
  • Fax:
Mailing address:
  • Phone: 347-706-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: