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General NPI Number Information
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NPI Number | 1053855809
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Entity Type | Individual
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Provider Name | KEYDELLA FULLER APN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | UF HEALTH 15255 MAX LEGGETT PARKWAY, SUITE 3600
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City | JACKSONVILLE
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State | FL
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Zip | 32218
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Country | US
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Telephone | 904-383-1011
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Fax | 904-383-1411
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Provider Business Mailing Address
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Address Line | 15255 MAX LEGGETT PKWY STE 3600
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7279
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Country | US
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Telephone | 904-383-1011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11012620
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00692900
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License Number State | NJ
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