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General NPI Number Information
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NPI Number | 1619614930
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Entity Type | Individual
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Provider Name | TAMMY LYNN FULLER APRN
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Gender | Female
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 161 N. CAUSEWAY STE. C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169
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Country | US
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Telephone | 386-424-8440
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Fax | 386-426-8839
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Provider Business Mailing Address
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Address Line | 161 N. CAUSEWAY STE. C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169
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Country | US
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Telephone | 386-424-8440
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Fax | 386-426-8839
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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 | 11018505
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License Number State | FL
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