Individual
TIANA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
611 31ST AVE SW, PUYALLUP, WA 98373-3723
(253) 848-5951
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 845-7073
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
WA
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/22/2025
Last updated
01/22/2026
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