Provider Demographics
NPI:1407095425
Name:KUNKLE, MICHELE MILLS (LPN,CSFA,CSA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MILLS
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:LPN,CSFA,CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CANDYCE DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9629
Mailing Address - Country:US
Mailing Address - Phone:941-539-5443
Mailing Address - Fax:941-445-5218
Practice Address - Street 1:116 CANDYCE DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9629
Practice Address - Country:US
Practice Address - Phone:941-539-5443
Practice Address - Fax:941-445-5218
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
FLPN 1325501246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-4209156OtherEIN