Individual
BRYANT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 824-4990
(904) 824-2226
Mailing address
1605 LAKES PKWY, LAWRENCEVILLE, GA 30043-5858
(904) 819-4478
(904) 819-4993
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP995682
FL
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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