Provider Demographics
NPI:1326349002
Name:FAULKNER, ARIEL (RD LD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 MANG PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5752
Mailing Address - Country:US
Mailing Address - Phone:267-825-6491
Mailing Address - Fax:
Practice Address - Street 1:20020 VETERANS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2112
Practice Address - Country:US
Practice Address - Phone:941-613-1790
Practice Address - Fax:941-627-3553
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN00CCOtherBCBS
FLN00CCOtherBCBS