Healthcare Provider Details

I. General information

NPI: 1093715674
Provider Name (Legal Business Name): TODD CHARLES HULL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 US HIGHWAY 1 STE 5
SEBASTIAN FL
32958-3773
US

IV. Provider business mailing address

13000 US HIGHWAY 1 STE 5
SEBASTIAN FL
32958-3773
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-5881
  • Fax: 772-581-5883
Mailing address:
  • Phone: 772-581-5881
  • Fax: 772-581-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number371
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: