Provider Demographics
NPI:1609077692
Name:MCNULTY, SUN O (CNA)
Entity Type:Individual
Prefix:
First Name:SUN
Middle Name:O
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22928 EAGLES WATCH DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4787
Mailing Address - Country:US
Mailing Address - Phone:813-929-0733
Mailing Address - Fax:
Practice Address - Street 1:22928 EAGLES WATCH DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4787
Practice Address - Country:US
Practice Address - Phone:813-929-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA62341376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide