Provider Demographics
NPI:1528865938
Name:DILULLO, LOGAN (MSN, RN)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:DILULLO
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LOGAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8347 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0110
Mailing Address - Country:US
Mailing Address - Phone:256-998-4323
Mailing Address - Fax:
Practice Address - Street 1:8383 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6039
Practice Address - Country:US
Practice Address - Phone:256-998-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-193393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse