Provider Demographics
NPI:1306820196
Name:TULLOS, TERESA L (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:TULLOS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CENTERVILLE RD
Mailing Address - Street 2:STE 4200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4655
Mailing Address - Country:US
Mailing Address - Phone:850-877-3549
Mailing Address - Fax:
Practice Address - Street 1:1405 CENTERVILLE RD
Practice Address - Street 2:STE 4200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4655
Practice Address - Country:US
Practice Address - Phone:850-877-3549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP738322163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306820196Medicare PIN