Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carissa Sharnetta Fuller, CRNP

Individual provider Gerontology Nurse Practitioner · NPI 1407070501

Carissa Sharnetta Fuller, CRNP is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2006, 20 years ago. Practices with Vidant Medical Group LLC, a 974-clinician group and accepts Medicare assignment. Licensed in Delaware and Pennsylvania.

Years since qualifying
20
Licensed in
DE, PA
In the registry since
2007
Specialties on file
2
What do these letters mean?
CRNP — Certified Registered Nurse Practitioner
The title Pennsylvania and some other states use for a nurse practitioner.

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Practice location Address checks out

3401 N Broad St
Philadelphia, PA 19140-5103
Phone: (215) 707-1800
Fax: (215) 707-3644
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence SP009193 (PA)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence LP0000308 (DE)

Record details

NPI number1407070501
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNP
Sole proprietorNo
NPI enumeratedApril 12, 2007
Last updated in NPPESFebruary 15, 2023
Certification dateFebruary 15, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Vidant Medical Group Llc — 974 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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