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

Jeremy Wayne Fuller, NP-C

Individual provider Nurse Practitioner · NPI 1285221440

Jeremy Wayne Fuller, NP-C is a Nurse Practitioner in Santa Rosa, California. Qualified in 2020, 6 years ago. Practices with Evolve Restorative Center, an 8-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2020
Specialties on file
2
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

220 Concourse Blvd
Santa Rosa, CA 95403-8210
Phone: (844) 527-7369
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95015009 (CA)
Nurse Practitioner Taxonomy 363L00000X · Licence 95015009 (CA)

Record details

NPI number1285221440
Entity typeIndividual (Type 1)
GenderMale
Credentials NP-C
Sole proprietorNo
NPI enumeratedDecember 22, 2020
Last updated in NPPESFebruary 24, 2025
Certification dateFebruary 24, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Evolve Restorative Center — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Santa Rosa