Provider Demographics
NPI:1801863006
Name:TULLY, LINDA W (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:W
Last Name:TULLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CARMICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950
Mailing Address - Country:US
Mailing Address - Phone:207-696-3992
Mailing Address - Fax:207-696-3974
Practice Address - Street 1:8 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950
Practice Address - Country:US
Practice Address - Phone:207-696-3992
Practice Address - Fax:207-696-3974
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026453363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME313490099Medicaid
P13540Medicare UPIN
ME313490099Medicaid