Provider Demographics
NPI:1912334095
Name:FULLERTON, ALLISON N (LPN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:N
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3387
Mailing Address - Country:US
Mailing Address - Phone:863-491-7580
Mailing Address - Fax:863-491-7584
Practice Address - Street 1:34 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3387
Practice Address - Country:US
Practice Address - Phone:863-491-7580
Practice Address - Fax:863-491-7584
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5162961164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN5162961OtherFLORIDA LICENSE