Provider Demographics
NPI:1144747304
Name:TATULLI, SANDRA LYNNE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNNE
Last Name:TATULLI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LYNNE
Other - Last Name:MILELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2088
Mailing Address - Country:US
Mailing Address - Phone:732-232-0699
Mailing Address - Fax:
Practice Address - Street 1:1945 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-775-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00755900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner