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NPI Code Detail

MEDICARE: DR. JENNIFER CARROLL FULTON MD

MEDICARE: DR. JENNIFER CARROLL FULTON MD
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
1207R00000XInternal Medicine PhysicianME104269FL
2207RC0200XCritical Care Medicine (Internal Medicine) PhysicianME104269FL
3207RP1001XPulmonary Disease PhysicianME 104269FL
4207RP1001XPulmonary Disease PhysicianME104269FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083783609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER CARROLL FULTON MD
Provider Business Mailing Address
First Line : 1325 SAN MARCO BLVD STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8567
Country : US
Telephone Number : 904-253-6910
Fax Number : 904-253-6964
Provider Business Practice Location Address
First Line : 1325 SAN MARCO BLVD STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8567
Country : US
Telephone Number : 904-253-6910
Fax Number : 904-253-6964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 10/26/2022

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