Provider Demographics
NPI:1235635681
Name:FAGINS, ARIEL KYNDAL
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:KYNDAL
Last Name:FAGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2625
Mailing Address - Country:US
Mailing Address - Phone:850-345-6789
Mailing Address - Fax:
Practice Address - Street 1:1725 N WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2625
Practice Address - Country:US
Practice Address - Phone:850-345-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health