MEDICARE: DR. JENNIFER RUTH FULMER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY6630	FL

General Provider Information

NPI Number	:	1013134840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER RUTH FULMER PHD

Provider Business Mailing Address
First Line	:	10000 STIRLING RD
Second Line	:	SUITE 6
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8067
Country	:	US
Telephone Number	:	954-436-8326
Fax Number	:	954-433-0603

Provider Business Practice Location Address
First Line	:	10000 STIRLING RD
Second Line	:	SUITE 6
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8067
Country	:	US
Telephone Number	:	954-436-8326
Fax Number	:	954-433-0603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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