Provider Demographics
NPI:1063512648
Name:FULTON, ISABELITA BAJARIAS (ARNP)
Entity type:Individual
Prefix:MS
First Name:ISABELITA
Middle Name:BAJARIAS
Last Name:FULTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2074 LOMA LINDA WAY N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4110
Mailing Address - Country:US
Mailing Address - Phone:727-443-0114
Mailing Address - Fax:
Practice Address - Street 1:3258 PARKSIDE CENTER CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-0907
Practice Address - Country:US
Practice Address - Phone:813-635-0595
Practice Address - Fax:813-635-0691
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3069792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health