Provider Demographics
NPI:1265006670
Name:FULLER, LINDSEY BLAIR
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BLAIR
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ROYAL DUNES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-4740
Mailing Address - Country:US
Mailing Address - Phone:407-222-5419
Mailing Address - Fax:
Practice Address - Street 1:151 ROYAL DUNES BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-4740
Practice Address - Country:US
Practice Address - Phone:407-222-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider