Provider Demographics
NPI:1063782589
Name:FULP, TOMIKIA D (LPN)
Entity type:Individual
Prefix:
First Name:TOMIKIA
Middle Name:D
Last Name:FULP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27651 MILLS AVE APT J
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3034
Mailing Address - Country:US
Mailing Address - Phone:216-278-2641
Mailing Address - Fax:
Practice Address - Street 1:27651 MILLS AVE APT J
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3034
Practice Address - Country:US
Practice Address - Phone:216-372-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.137189-M-IV164W00000X
OHAPRN.CNP481207363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No164W00000XNursing Service ProvidersLicensed Practical Nurse