Provider Demographics
NPI:1144695842
Name:FULTON, AUBREY (ARNP)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:FULTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 TAMIAMI TRL E STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6887
Mailing Address - Country:US
Mailing Address - Phone:239-799-7219
Mailing Address - Fax:239-799-7209
Practice Address - Street 1:4270 TAMIAMI TRL E STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6887
Practice Address - Country:US
Practice Address - Phone:239-799-7219
Practice Address - Fax:239-799-7209
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9319076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2DG0EOtherBCBS
FL016265800Medicaid
FLIK340ZOtherMEDICARE
FL016265800Medicaid