Healthcare Provider Details

I. General information

NPI: 1518259464
Provider Name (Legal Business Name): TASIA NICOLE HULST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TASIA NICOLE HALADY

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S KITSAP BLVD STE 250
PORT ORCHARD WA
98366-3739
US

IV. Provider business mailing address

450 S KITSAP BLVD STE 250
PORT ORCHARD WA
98366-3739
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-3000
  • Fax: 360-782-3040
Mailing address:
  • Phone: 360-782-3000
  • Fax: 360-782-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD178546
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61102534
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: