Provider Demographics
NPI:1376088286
Name:TULLISON, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TULLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:CHARISSE
Other - Last Name:TULLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7617 GLEN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4653
Mailing Address - Country:US
Mailing Address - Phone:901-218-6151
Mailing Address - Fax:901-369-4912
Practice Address - Street 1:7617 GLEN CREEK LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4653
Practice Address - Country:US
Practice Address - Phone:901-218-6151
Practice Address - Fax:901-369-4912
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
TN140189374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No252Y00000XAgenciesEarly Intervention Provider Agency