Provider Demographics
NPI:1083741805
Name:REPPENHAGEN HULL, BRIAR (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRIAR
Middle Name:
Last Name:REPPENHAGEN HULL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 COLLEGE AVE E
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5220
Mailing Address - Country:US
Mailing Address - Phone:813-645-5355
Mailing Address - Fax:813-645-5355
Practice Address - Street 1:3020 COLLEGE AVE E
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5220
Practice Address - Country:US
Practice Address - Phone:813-645-5355
Practice Address - Fax:813-645-5355
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY402231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003209700Medicaid
FLS1115OtherBLUECROSS BLUESHIELD
FLJ0731OtherBLUECROSS BLUESHIELD
FLJ0731OtherBLUECROSS BLUESHIELD