MEDICARE: MR. MARC BRYAN HULL P.A.

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	363AM0700X	Medical Physician Assistant	PA 9104001	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA 9104001	OTHER	FL	PA LICENSE

General Provider Information

NPI Number	:	1326195876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC BRYAN HULL P.A.

Provider Business Mailing Address
First Line	:	1860 RENZULLI RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-1726
Country	:	US
Telephone Number	:	386-663-3061
Fax Number	:	386-663-3066

Provider Business Practice Location Address
First Line	:	1860 RENZULLI RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-1726
Country	:	US
Telephone Number	:	386-663-3061
Fax Number	:	386-663-3066

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/18/2016

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Directions to “ MR. MARC BRYAN HULL P.A.” Practice Location

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