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NPI Code Detail

MEDICARE: PAULA B. FULLER CRNA

MEDICARE: PAULA B. FULLER CRNA
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
1367500000XCertified Registered Nurse AnesthetistAPRN588412FL

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 : 1679548796
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA B. FULLER CRNA
Provider Business Mailing Address
First Line : 619 20TH ST
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32084-1703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 611 ZEAGLER DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-3810
Country : US
Telephone Number : 386-326-8080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 02/14/2022

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Directions to “ PAULA B. FULLER CRNA” Practice Location

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