Provider Demographics
NPI:1215131677
Name:NULTY, DOROTHY JEAN (ARNP)
Entity type:Individual
Prefix:MR
First Name:DOROTHY
Middle Name:JEAN
Last Name:NULTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3723
Mailing Address - Country:US
Mailing Address - Phone:813-746-8070
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6927
Practice Address - Country:US
Practice Address - Phone:954-253-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9239332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily