Healthcare Provider Details

I. General information

NPI: 1104763127
Provider Name (Legal Business Name): NURIDA KEMELBEK FUNK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

IV. Provider business mailing address

229 BAYOU WOODS DR NW
FORT WALTON BEACH FL
32548-4316
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7331
  • Fax:
Mailing address:
  • Phone: 734-682-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN44461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: