MEDICARE: TANSHA FULLER

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	163WH0200X	Home Health Registered Nurse	F46081979620	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033717236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANSHA FULLER

Provider Business Mailing Address
First Line	:	8606 N 10TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-1712
Country	:	US
Telephone Number	:	813-638-4273
Fax Number	:

Provider Business Practice Location Address
First Line	:	8606 N 10TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-1712
Country	:	US
Telephone Number	:	813-638-4273
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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Directions to “ TANSHA FULLER ” Practice Location

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