Provider Demographics
NPI:1467730176
Name:KUNKLE, LEE ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LEE ANN
Middle Name:
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1623
Mailing Address - Country:US
Mailing Address - Phone:954-632-0900
Mailing Address - Fax:
Practice Address - Street 1:2900 SOUTH COMMERCE PARKWAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3622
Practice Address - Country:US
Practice Address - Phone:954-385-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP899742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics