Healthcare Provider Details

I. General information

NPI: 1417428681
Provider Name (Legal Business Name): MADISON DANIELLE PULS HAS, B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON DANIELLE RAFOLS

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33385 US HIGHWAY 19 N
PALM HARBOR FL
34684-3128
US

IV. Provider business mailing address

15702 CRYING WIND DR
TAMPA FL
33624-1559
US

V. Phone/Fax

Practice location:
  • Phone: 727-781-1760
  • Fax: 727-786-8477
Mailing address:
  • Phone: 813-928-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: