Provider Demographics
NPI:1720147952
Name:HULTSTRAND, HILLARY O'SHEA (MD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:O'SHEA
Last Name:HULTSTRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7747
Mailing Address - Country:US
Mailing Address - Phone:850-479-4791
Mailing Address - Fax:850-494-2260
Practice Address - Street 1:1921 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7747
Practice Address - Country:US
Practice Address - Phone:850-479-4791
Practice Address - Fax:850-494-2260
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94515208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274632800Medicaid
FLU7015ZMedicare ID - Type Unspecified
FL274632800Medicaid