Healthcare Provider Details

I. General information

NPI: 1285771444
Provider Name (Legal Business Name): KRISTIN L WULFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W PINE AVE
LONGWOOD FL
32750-4138
US

IV. Provider business mailing address

218 RIVER BLUFF DR
ORMOND BEACH FL
32174-3835
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-4499
  • Fax: 407-339-4903
Mailing address:
  • Phone: 386-852-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME104612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: