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General NPI Number Information
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NPI Number | 1427888163
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Entity Type | Individual
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Provider Name | REBECCA FULLER MSN, BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 11948 BALM RIVERVIEW RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-6601
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Country | US
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Telephone | 813-236-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 2476 CORONADO WAY
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City | DUNEDIN
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State | FL
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Zip | 34698-2033
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN11042771
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License Number State | FL
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