Basic Information
| Provider Information | |||||||||
| NPI: | 1851727903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TULLO | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064372747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779253637 | ||||||||
| FaxNumber: | 2037856798 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064372747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779253637 | ||||||||
| FaxNumber: | 2037856798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 005513 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 005513 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 005513 | 01 | CT | LICENSE | OTHER | 004234788 | 05 | CT | MEDICAID |