Healthcare Provider Details

I. General information

NPI: 1164997359
Provider Name (Legal Business Name): ADRIANA PUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4094 69TH TER N
PINELLAS PARK FL
33781-5809
US

IV. Provider business mailing address

4094 69TH TER N
PINELLAS PARK FL
33781-5809
US

V. Phone/Fax

Practice location:
  • Phone: 813-415-5201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: