Active NPI
Patricia Tully, RN
- Nurse Practitioner
- Orange, CA
National Provider Identifier
1073767901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- NP18628
- Practice address
- 101 The City Dr S
Orange, CA 92868-3201 - Phone
- (714) 456-8068
- Fax
- (714) 456-2979
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN563494 | CA | |
| Nurse Practitioner | 363L00000X | NP18628 | CA | Primary |
Addresses
Primary practice location
101 The City Dr S
Orange, CA 92868-3201
Mailing address
PO Box 54778
Los Angeles, CA 90054-0778
Phone (714) 456-8068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN563494 | CA | MD | Registered Nurse |
| NP18628 | CA | MD | Nurse Practitioner |
| 18628 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1073767901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 54778",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900540778",
"telephone_number": "714-456-8068",
"fax_number": "714-456-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 THE CITY DR S",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683201",
"telephone_number": "714-456-8068",
"fax_number": "714-456-2979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLY",
"first_name": "PATRICIA",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "RN563494",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "NP18628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.