Individual ProviderKimberly J FullerNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865(904) 953-2000PECOS EnrollmentBased on the most recent information from CMS, provider Kimberly J Fuller does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1033255567Provider TypeIndividualFull NameFuller, Kimberly JCredentialNPGenderFemaleSole ProprietorNoEnumeration Date1/30/2007Last Updated2/18/2021Contact InformationPractice LocationPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865Phone(904) 953-2000FaxUnlisted FaxMailing LocationMailing Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP1167782Florida