Provider Demographics
NPI:1255971644
Name:FULLER, JULIA (APRN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:FULLER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 US HIGHWAY 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3289
Mailing Address - Country:US
Mailing Address - Phone:772-581-8003
Mailing Address - Fax:772-581-8005
Practice Address - Street 1:14430 US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3289
Practice Address - Country:US
Practice Address - Phone:772-597-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005736363LF0000X
FLAPRN11005736363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily