Provider Demographics
NPI:1265853048
Name:FULLER, TORICA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TORICA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4401
Mailing Address - Country:US
Mailing Address - Phone:910-433-3710
Mailing Address - Fax:910-433-3695
Practice Address - Street 1:1235 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3710
Practice Address - Fax:910-433-3695
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily