Doctor Name: | MRS. MARY ELIZABETH TULLOS |
NPI Number: | 1639339682 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | R869304 |
Business Practice Address: | 1150 Casino Strip Resort Blvd Robinsonville, MS - 38664 |
Business Phone Number: | 6623577707 |
Business Fax Number: | 6623577807 |
Mailing Address: | 1150 Casino Strip Resort Blvd, Hollywood Wellness Clinic ROBINSONVILLE |
State: | MS |
Postal Code: | 38664 |
Phone Number: | 6623577707 |
Fax Number: | 6623577807 |
NPI Enumeration Date: | 06/12/2008 |
NPI Last Update Date: | 10/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R869304 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |