MEDICARE: ANNA MARIA FULLER RN

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	163W00000X	Registered Nurse	9502030	FL

General Provider Information

NPI Number	:	1609443449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIA FULLER RN

Provider Business Mailing Address
First Line	:	3043 HOLLAND DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7171
Country	:	US
Telephone Number	:	407-797-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3043 HOLLAND DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7171
Country	:	US
Telephone Number	:	407-797-6391
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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