Individual
MRS. JEANETTE TULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMS, PA-C
Contact information
Practice address
2307 W BROWARD BLVD STE 200, FORT LAUDERDALE, FL 33312-1420
(954) 792-1010
(954) 792-1199
Mailing address
4948 NW 49TH CT, COCONUT CREEK, FL 33073-4908
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
9109893
FL
363AS0400X
Surgical Physician Assistant
Primary
9109893
FL
Other
Enumeration date
09/27/2016
Last updated
04/26/2024
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