Individual
ANGELA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1923 PORT ROYAL DR, SODDY DAISY, TN 37379-8836
(423) 602-1544
Mailing address
1923 PORT ROYAL DR, SODDY DAISY, TN 37379-8836
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
25268
TN
Other
Enumeration date
03/14/2019
Last updated
03/14/2019
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