Healthcare Provider Details

I. General information

NPI: 1487559381
Provider Name (Legal Business Name): TODD BULGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2026
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3574
RIVERVIEW FL
33568-3574
US

IV. Provider business mailing address

PO BOX 3574
RIVERVIEW FL
33568-3574
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-3283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number19530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1348361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: