Healthcare Provider Details

I. General information

NPI: 1619979457
Provider Name (Legal Business Name): JENNEFFER PULAPAKA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N STONE ST STE 208
DELAND FL
32720
US

IV. Provider business mailing address

844 N STONE ST STE 208
DELAND FL
32720-3208
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-3733
  • Fax: 386-738-3733
Mailing address:
  • Phone: 386-738-3733
  • Fax: 888-797-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: