Provider Demographics
NPI:1619979457
Name:PULAPAKA, JENNEFFER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNEFFER
Middle Name:
Last Name:PULAPAKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 N STONE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3208
Mailing Address - Country:US
Mailing Address - Phone:386-738-3733
Mailing Address - Fax:386-738-3733
Practice Address - Street 1:844 N STONE ST STE 208
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-3733
Practice Address - Fax:386-738-3733
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3160213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340518400Medicaid
FL65873ZMedicare ID - Type UnspecifiedPODIATRY
FL340518400Medicaid