Individual
TERRY RAE DULLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6274 33RD AVE N, ST PETERSBURG, FL 33710-2406
(715) 271-3046
Mailing address
801 W GORDON ST, THOMASTON, GA 30286-3426
(706) 646-5725
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9470158
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124995088
PINELLAS COUNTY VOTER ID CARD
FL
01
—
9470158
RN MULTISTATE LICENSE
FL
01
—
D400816605850
STATE OF FLORIDA DRIVERS LICENSE
FL
Enumeration date
04/24/2018
Last updated
04/24/2018
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