Healthcare Provider Details

I. General information

NPI: 1194637454
Provider Name (Legal Business Name): KYLE RICHARD PAULSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SOUTHSHORE AVE
TAMPA FL
33621-5022
US

IV. Provider business mailing address

13023 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

V. Phone/Fax

Practice location:
  • Phone: 202-627-0880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: