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General NPI Number Information
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NPI Number | 1124655519
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Entity Type | Individual
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Provider Name | ROBIN FULLER APRN
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 180 KENNEDY MEMORIAL DR
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City | WATERVILLE
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State | ME
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Zip | 04901-4540
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Country | US
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Telephone | 207-859-8721
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Fax |
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Provider Business Mailing Address
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Address Line | 25811 CRIPPEN DR
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City | LAND O LAKES
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State | FL
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Zip | 34639-5723
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Country | US
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Telephone | 717-882-9122
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11003124
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License Number State | FL
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