Provider Demographics
NPI:1558552091
Name:TULL, CINDRA E (FNP)
Entity Type:Individual
Prefix:
First Name:CINDRA
Middle Name:E
Last Name:TULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5681
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801
Mailing Address - Country:US
Mailing Address - Phone:417-831-0150
Mailing Address - Fax:417-865-3479
Practice Address - Street 1:440 E. TAMPA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806
Practice Address - Country:US
Practice Address - Phone:417-831-0150
Practice Address - Fax:417-865-3479
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427018908Medicaid
MO500410006Medicare PIN
MO327373268Medicare PIN