Healthcare Provider Details

I. General information

NPI: 1073992756
Provider Name (Legal Business Name): HULBERT FOOT AND ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-5444
US

IV. Provider business mailing address

1225 FOX DR
ENGLEWOOD FL
34223-4617
US

V. Phone/Fax

Practice location:
  • Phone: 920-216-0011
  • Fax:
Mailing address:
  • Phone: 920-216-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3716
License Number StateFL

VIII. Authorized Official

Name: DR. NELSON C HULBERT
Title or Position: OWNER
Credential: D.P.M.
Phone: 920-216-0011