Healthcare Provider Details

I. General information

NPI: 1487843595
Provider Name (Legal Business Name): SOFIA TUNDEL KULAKOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 VENETIAN CT STE 1
NAPLES FL
34109-8728
US

IV. Provider business mailing address

2235 VENETIAN CT STE 1
NAPLES FL
34109-8728
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-9337
  • Fax: 301-951-7011
Mailing address:
  • Phone: 850-304-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-003587
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9104304
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004536
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: