Provider Demographics
NPI:1306211537
Name:FULLERTON, ANGELICA FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:FAYE
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NATTC NBHC
Mailing Address - Street 2:760 EAST AVE., BLDG 3911
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508
Mailing Address - Country:US
Mailing Address - Phone:850-452-8970
Mailing Address - Fax:
Practice Address - Street 1:NBHC NAS PENSACOLA
Practice Address - Street 2:450 TURNER ST
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508
Practice Address - Country:US
Practice Address - Phone:850-452-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.140081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice