| Doctor Name: | JILL ELIZABETH FULLER |
| NPI Number: | 1154574416 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 5403 |
| Business Practice Address: | 1022 Storrs Rd Storrs Mansfield, CT - 062682633 |
| Business Phone Number: | 8604299321 |
| Business Fax Number: | 8604294775 |
| Mailing Address: | 1022 Storrs Rd, STORRS MANSFIELD |
| State: | CT |
| Postal Code: | 062682633 |
| Phone Number: | 8604299321 |
| Fax Number: | 8604294775 |
| NPI Enumeration Date: | 10/30/2008 |
| NPI Last Update Date: | 08/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5403 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |