Provider Demographics
NPI:1992743694
Name:FULFORD, PAULA CONETTE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:CONETTE
Last Name:FULFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:CONETTE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 E JAMES LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-3127
Mailing Address - Country:US
Mailing Address - Phone:850-683-1251
Mailing Address - Fax:
Practice Address - Street 1:449 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4507
Practice Address - Country:US
Practice Address - Phone:850-767-2200
Practice Address - Fax:850-767-2201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1649482363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal