Provider Demographics
NPI:1386841674
Name:TULLA, MICHELLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:TULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:TULLA LLAUGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5424
Mailing Address - Country:US
Mailing Address - Phone:904-260-2565
Mailing Address - Fax:
Practice Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5424
Practice Address - Country:US
Practice Address - Phone:904-260-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17604207V00000X
FLME120841207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty