Provider Demographics
NPI:1669813747
Name:FULLER, JAMES BRANDON (DAOM, AP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRANDON
Last Name:FULLER
Suffix:
Gender:M
Credentials:DAOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6558 TARAWA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-5644
Mailing Address - Country:US
Mailing Address - Phone:941-724-0827
Mailing Address - Fax:
Practice Address - Street 1:3205 SOUTHGATE CIR STE 7
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:941-724-0827
Practice Address - Fax:941-296-7446
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP3193OtherACUPUNCTURE