Basic Information
| Provider Information | |||||||||
| NPI: | 1821766619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEMBHARD | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | ANGELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 SOMERSET DR APT C401 | ||||||||
| Address2: | |||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333111935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862735413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4161 TAMIAMI TRL STE 401 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339529254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412352710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2021 | ||||||||
| LastUpdateDate: | 09/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.