NPIMap

Individual provider Active NPI

Tanya Fuller-Pellin, FNP

  • Family Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1639544240
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19819 Issued in SC
Practice address
255 Enterprise Blvd Ste 101
Greenville, SC 29615-3530
Phone
(864) 454-8120
Fax
(864) 454-8125
NPI assigned
Dec 8, 2015
Last updated
Aug 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19819 SC Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 19819 SC

Addresses

Primary practice location

255 Enterprise Blvd Ste 101
Greenville, SC 29615-3530

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

220 Keowee Trl
Clemson, SC 29631-1448
Phone (864) 653-4071

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160210001473 SC Practitioner - Nurse Practitioner 3173827250 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

255 Enterprise Blvd
Greenville, SC 29615-6300
Phone (864) 454-8120

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.33 of 100Reported as group
Quality
75.48
Promoting interoperability
100
Improvement activities
40
Cost
72.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jul 22, 2024 Accepting new patients
Internal Medicine and Cardiology CurrentSince Jan 7, 2017 Accepting new patients
Prisma Health University Medical Group CurrentSince Jul 22, 2024 Accepting new patients
Providence House Calls LLC CurrentSince Aug 8, 2023 Accepting new patients
Internal Medicine and Cardiology Past Accepting new patients

Locations

101 Chapman Hill Rd
Ste 201
Clemson, SC 29631
Phone (864) 653-4071

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

255 Enterprise Blvd
Greenville, SC 29615
Phone (864) 454-0888

255 Enterprise Blvd
Ste 101
Greenville, SC 29615
Phone (864) 297-4929

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

401 Guess St
#100
Greenville, SC 29605
Phone (864) 233-2744

401 Guess St
Ste 100
Greenville, SC 29605
Phone (864) 233-2744

220 Scuffletown Rd
Simpsonville, SC 29681
Phone 8642332744 ext. 2812

634 Fairview Rd
Simpsonville, SC 29680
Phone (843) 851-3126

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJFFBA
  • Direct secure messaging: tfullerpellin725037@direct.ghs.myhfn.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1639544240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 ENTERPRISE BLVD STE 101",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153530",
            "telephone_number": "864-454-8120",
            "fax_number": "864-454-8125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Keowee Trl",
            "address_purpose": "LOCATION",
            "city": "Clemson",
            "state": "SC",
            "postal_code": "296311448",
            "country_code": "US",
            "telephone_number": "864-653-4071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER-PELLIN",
        "first_name": "TANYA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-08",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19819",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "19819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.