Individual
BONNIE NALL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
16 LAKESHORE DR, YALAHA, FL 34797-3032
(850) 960-6038
Mailing address
16 LAKESHORE DR, YALAHA, FL 34797-3032
(850) 960-6038
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN11012161
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN11012161
FLORIDA DEPARTMENT OF HEALTH BOARD OF NURSING
FL
Enumeration date
03/17/2021
Last updated
03/25/2024
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