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General NPI Number Information
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NPI Number | 1699649772
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Entity Type | Organization
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Legal Business Name | FULLER HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 910 S 8TH ST STE 205
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3771
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Country | US
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Telephone | 904-895-6433
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Fax | 904-747-1141
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Provider Business Mailing Address
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Address Line | 910 S 8TH ST STE 205
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3771
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Country | US
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Telephone | 904-895-6433
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Fax | 904-747-1141
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KEYDELLA FULLER
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Credential | APRN
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Telephone | 904-895-6433
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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 |
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License Number State |
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