Provider Demographics
NPI:1487843595
Name:KULAKOWSKI, SOFIA TUNDEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:TUNDEL
Last Name:KULAKOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 VENETIAN CT STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-8728
Mailing Address - Country:US
Mailing Address - Phone:850-304-1033
Mailing Address - Fax:
Practice Address - Street 1:2235 VENETIAN CT STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-8728
Practice Address - Country:US
Practice Address - Phone:239-596-9337
Practice Address - Fax:301-951-7011
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-003587363A00000X
363A00000X
FLPA 9104304363A00000X
MDC0004536363A00000X
TXPA06931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01025418OtherRAILROAD MEDICARE
MDP01025418OtherRAILROAD MEDICARE