Healthcare Provider Details

I. General information

NPI: 1801074885
Provider Name (Legal Business Name): JOHN F HULL DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 N SUMMIT ST
CRESCENT CITY FL
32112-1724
US

IV. Provider business mailing address

921 N SUMMIT ST
CRESCENT CITY FL
32112-1724
US

V. Phone/Fax

Practice location:
  • Phone: 386-698-2101
  • Fax: 386-698-2364
Mailing address:
  • Phone: 386-698-2101
  • Fax: 386-698-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0004047
License Number StateFL

VIII. Authorized Official

Name: MS. TAMMY D YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-698-2101