Healthcare Provider Details

I. General information

NPI: 1306204938
Provider Name (Legal Business Name): ASHLEIGH PULLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 TULIP TREE CIR
SEFFNER FL
33584-5876
US

IV. Provider business mailing address

2628 TULIP TREE CIR
SEFFNER FL
33584-5876
US

V. Phone/Fax

Practice location:
  • Phone: 904-993-9181
  • Fax:
Mailing address:
  • Phone: 904-993-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA14983
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: