Healthcare Provider Details

I. General information

NPI: 1376823864
Provider Name (Legal Business Name): JO ANN CULLEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MALLETT WAY
BLUFFTON SC
29910-6064
US

IV. Provider business mailing address

26 PEBBLEBROOK CT
GREER SC
29651-1935
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-6699
  • Fax: 843-815-6695
Mailing address:
  • Phone: 813-334-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9186216
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20192
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: