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Individual

JUSTIN SCOTT FULKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ACNP-BC, CRNA

Contact information

Practice address
6766 W SUNRISE BLVD STE 100, PLANTATION, FL 33313-6072
(954) 583-8472
Mailing address
1997 NE 15TH AVE, WILTON MANORS, FL 33305-3262
(803) 730-2778

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
18087
SC
367500000X
Certified Registered Nurse Anesthetist
11018636
FL
367500000X
Certified Registered Nurse Anesthetist
209-009025
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209009025
IL

Other

Enumeration date
08/24/2011
Last updated
09/09/2025
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