Bettina Fulford, ARNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ARNP3088302 Issued in FL

Practice address

3512 S Atlantic Ave
Shores Medical Center
Daytona Beach Shores, FL 32118

Phone

(386) 767-9544

NPI assigned

Dec 3, 2014

Last updated

Feb 6, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3861/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423180800000",
    "number": "1336546506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 S ATLANTIC AVE",
            "city": "DAYTONA BEACH SHORES",
            "state": "FL",
            "postal_code": "321187639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 S ATLANTIC AVE",
            "address_2": "SHORES MEDICAL CENTER",
            "city": "DAYTONA BEACH SHORES",
            "state": "FL",
            "postal_code": "32118",
            "telephone_number": "386-767-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULFORD",
        "first_name": "BETTINA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2015-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ARNP3088302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Dominy, MA
• East Central Florida Outpatient Imaging, LLC (Radiology Associates Daytona Beach Shores)
• Elite Aesthetics, LLC (Elite Aesthetics Skin & Wellness Center)
• James Evensen, MA BCBA
• Zalika A Freeman
• David Gaughan, M,D.
• Gerald R Woodard DO PA (Shores Medical Center)
• Gerald R Woodard DO PA (Shores Medical Center Daytona)
• Lauren A Girard, DO
• Jamera F Givens

• Family Medicine Physician in Daytona Beach Shores, FL
• Providers in Daytona Beach Shores, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.