MEDICARE: JAMES KULIS APRN

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	363LF0000X	Family Nurse Practitioner	11010440	FL

General Provider Information

NPI Number	:	1942897293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KULIS APRN

Provider Business Mailing Address
First Line	:	905 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1705
Country	:	US
Telephone Number	:	386-767-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1705
Country	:	US
Telephone Number	:	386-767-9000
Fax Number	:

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	09/26/2021

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