Provider Demographics
NPI:1720228208
Name:FULLER, JOY LEE (APRN, MSN, BC)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:LEE
Last Name:FULLER
Suffix:
Gender:F
Credentials:APRN, MSN, BC
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 741424
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-1424
Mailing Address - Country:US
Mailing Address - Phone:561-853-7233
Mailing Address - Fax:561-619-9511
Practice Address - Street 1:6234 S CONGRESS AVE STE F1
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2307
Practice Address - Country:US
Practice Address - Phone:561-619-9510
Practice Address - Fax:561-619-9511
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2602122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner