Provider Demographics
NPI:1730538067
Name:TULLOS, ELIZABETH BROOKE (MD, MPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROOKE
Last Name:TULLOS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BROOKE
Other - Last Name:HONEYCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:UNIT 5210, BOX 230
Mailing Address - Street 2:
Mailing Address - City:RAF LAKENHEATH
Mailing Address - State:BRANDON
Mailing Address - Zip Code:IP27 9PN
Mailing Address - Country:AE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5210
Practice Address - Street 2:
Practice Address - City:RAF LAKENHEATH
Practice Address - State:APO
Practice Address - Zip Code:09461
Practice Address - Country:AE
Practice Address - Phone:016-385-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307291208800000X
FLME152359208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology