Provider Demographics
NPI:1518259464
Name:HULST, TASIA NICOLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:TASIA
Middle Name:NICOLE
Last Name:HULST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:TASIA
Other - Middle Name:NICOLE
Other - Last Name:HALADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 S KITSAP BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3739
Mailing Address - Country:US
Mailing Address - Phone:360-782-3000
Mailing Address - Fax:360-782-3040
Practice Address - Street 1:450 S KITSAP BLVD STE 250
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3739
Practice Address - Country:US
Practice Address - Phone:360-782-3000
Practice Address - Fax:360-782-3040
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178546208000000X
WAMD61102534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics