Individual
TIANNA JEAN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP, MSN
Contact information
Practice address
9898 S GLASGOW DR, SOUTH JORDAN, UT 84009-9113
(208) 409-5273
Mailing address
9898 S GLASGOW DR, SOUTH JORDAN, UT 84009-9113
(208) 409-5273
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9666776-8900
UT
Other
Enumeration date
06/09/2025
Last updated
06/09/2025
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