MEDICARE: MRS. CONSTANCE MARIE WULF A.P.

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	171100000X	Acupuncturist	AP2279	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP2279	OTHER	FL	ACUPUNCTURE

General Provider Information

NPI Number	:	1316047129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONSTANCE MARIE WULF A.P.

Provider Business Mailing Address
First Line	:	6000A SAWGRASS VILLAGE CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5011
Country	:	US
Telephone Number	:	904-994-3709
Fax Number	:	904-247-9366

Provider Business Practice Location Address
First Line	:	6000A SAWGRASS VILLAGE CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5011
Country	:	US
Telephone Number	:	904-994-3709
Fax Number	:

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/28/2022

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