Provider Demographics
NPI:1417428681
Name:PULS, MADISON DANIELLE (HAS, BS)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:DANIELLE
Last Name:PULS
Suffix:
Gender:F
Credentials:HAS, BS
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:DANIELLE
Other - Last Name:RAFOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15702 CRYING WIND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1559
Mailing Address - Country:US
Mailing Address - Phone:813-928-5204
Mailing Address - Fax:
Practice Address - Street 1:33385 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3128
Practice Address - Country:US
Practice Address - Phone:727-781-1760
Practice Address - Fax:727-786-8477
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5407237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101791300Medicaid
FL14389864OtherCAQH