Healthcare Provider Details

I. General information

NPI: 1568375087
Provider Name (Legal Business Name): KATHRYN FUNK AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 75TH ST NW
BRADENTON FL
34209-9446
US

IV. Provider business mailing address

3008 JUNCTION ST
NORTH PORT FL
34288-8232
US

V. Phone/Fax

Practice location:
  • Phone: 941-713-3767
  • Fax:
Mailing address:
  • Phone: 941-713-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: