Provider Demographics
NPI:1578871869
Name:BULLOCK, UHURU BINTI (APRN)
Entity Type:Individual
Prefix:MRS
First Name:UHURU
Middle Name:BINTI
Last Name:BULLOCK
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 1:2920 MALDIVE CT
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-7935
Mailing Address - Country:US
Mailing Address - Phone:516-375-2390
Mailing Address - Fax:
Practice Address - Street 1:2920 MALDIVE CT
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-7935
Practice Address - Country:US
Practice Address - Phone:516-375-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty