Provider Demographics
NPI:1982570586
Name:PULLEN, ABIGAIL (MT-BC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STATE RD 13 N
Mailing Address - Street 2:STE 106 - #195
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-305-2711
Mailing Address - Fax:
Practice Address - Street 1:450 STATE ROAD 13 N STE 106
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3863
Practice Address - Country:US
Practice Address - Phone:904-305-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist