Healthcare Provider Details

I. General information

NPI: 1750166146
Provider Name (Legal Business Name): SUMMER ELAINE TULEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

IV. Provider business mailing address

PO BOX 392552
PITTSBURGH PA
15251-2501
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9081
  • Fax: 260-483-9196
Mailing address:
  • Phone: 512-792-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014399A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4011022
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: