Provider Demographics
NPI:1699946830
Name:TULLIS, JEFFREY FIELD
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FIELD
Last Name:TULLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:TULLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5110 WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7317
Mailing Address - Country:US
Mailing Address - Phone:254-228-5864
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590113163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse