Individual
ANGELIA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1750 TREE BLVD STE 5, ST AUGUSTINE, FL 32084-5719
(904) 342-0672
Mailing address
1750 TREE BLVD STE 5, ST AUGUSTINE, FL 32084-5719
(904) 342-0672
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP9170137
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102979000
—
FL
Enumeration date
02/12/2014
Last updated
03/27/2023
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