Provider Demographics
NPI:1285771444
Name:WULFF, KRISTIN L (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:WULFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 RIVER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3835
Mailing Address - Country:US
Mailing Address - Phone:386-852-8646
Mailing Address - Fax:
Practice Address - Street 1:295 W PINE AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4138
Practice Address - Country:US
Practice Address - Phone:407-339-4499
Practice Address - Fax:407-339-4903
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00399032OtherMEDICARE RAILROAD ID#
FLCG240YMedicare PIN
ARP00399032OtherMEDICARE RAILROAD ID#
AR165026001Medicare PIN