Provider Demographics
NPI:1982629432
Name:FULLER, TERRI (APN)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:M
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:694 STATE ROUTE 15 S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2249
Mailing Address - Country:US
Mailing Address - Phone:973-288-1550
Mailing Address - Fax:973-288-1552
Practice Address - Street 1:694 RT 15 S. PLAZA
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849
Practice Address - Country:US
Practice Address - Phone:973-288-1550
Practice Address - Fax:973-288-1552
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07087000363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1891096848OtherADVANCED WOMEN'S HEALTH, LLC GROUP PIN
NJ814813177OtherTFNP,INC
NJ026205P65Medicare PIN