Healthcare Provider Details

I. General information

NPI: 1801070941
Provider Name (Legal Business Name): TONYA L FULK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVENUE
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5802
  • Fax:
Mailing address:
  • Phone: 216-444-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN202025, COA 03129
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP03129
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN202025NP03129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: