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General NPI Number Information
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NPI Number | 1790352607
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Entity Type | Individual
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Provider Name | SU KIM-HUMMEL
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 11661 PLANTATION PRESERVE CIR S
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City | FORT MYERS
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State | FL
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Zip | 33966-8372
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Country | US
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Telephone | 239-288-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 11661 PLANTATION PRESERVE CIR S
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City | FORT MYERS
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State | FL
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Zip | 33966-8372
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11013909
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9362737
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License Number State | FL
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