MEDICARE: KRISTEN NOEL BARNEKOV RULKA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102848	FL

General Provider Information

NPI Number	:	1033160981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NOEL BARNEKOV RULKA PA

Provider Business Mailing Address
First Line	:	300 CLYDE MORRIS BLVD
Second Line	:	SUITE C
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5956
Country	:	US
Telephone Number	:	386-673-5100
Fax Number	:	386-673-6014

Provider Business Practice Location Address
First Line	:	300 CLYDE MORRIS BLVD
Second Line	:	SUITE C
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5956
Country	:	US
Telephone Number	:	386-673-5100
Fax Number	:	386-673-6014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/14/2014

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