Individual
CARISSA SHARNETTA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-1800
(215) 707-3644
Mailing address
3500 N BROAD ST RM 1A, PHILADELPHIA, PA 19140-4106
(215) 926-9022
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP009193
PA
363LG0600X
Gerontology Nurse Practitioner
LP0000308
DE
Other
Enumeration date
04/12/2007
Last updated
02/15/2023
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