Provider Demographics
NPI:1710784277
Name:TULLY, ERIN (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TULLY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 HAMLET DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-7501
Mailing Address - Country:US
Mailing Address - Phone:952-215-7715
Mailing Address - Fax:
Practice Address - Street 1:2526 HAMLET DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-7501
Practice Address - Country:US
Practice Address - Phone:952-215-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant