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General NPI Number Information
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NPI Number | 1780146878
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Entity Type | Individual
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Provider Name | JESSICA R TULLIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 5700 MONROE ST UNIT 206
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City | SYLVANIA
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State | OH
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Zip | 43560-2735
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Country | US
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Telephone | 419-473-6601
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Fax | 419-479-6966
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST FL 7
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 57.247691
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.143458
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License Number State | OH
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