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General NPI Number Information
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NPI Number | 1679338784
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Entity Type | Individual
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Provider Name | NARDRIA R KUNKEL MSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 3592 BROADWAY STE 110
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City | FORT MYERS
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State | FL
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Zip | 33901-8056
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Country | US
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Telephone | 954-907-0435
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Fax |
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Provider Business Mailing Address
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Address Line | 7821 49TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-7971
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Country | US
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Telephone | 954-907-0435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW17524
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License Number State | FL
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