Provider Demographics
NPI:1902417728
Name:FULBRIGHT, ALICIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:362 COUNTY ROAD 782
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-5101
Mailing Address - Country:US
Mailing Address - Phone:423-744-4949
Mailing Address - Fax:
Practice Address - Street 1:305 GRADY RD STE B
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1903
Practice Address - Country:US
Practice Address - Phone:423-263-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily