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General NPI Number Information
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NPI Number | 1548656960
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Entity Type | Individual
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Provider Name | COURTNEY RENAE KONKEL D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 2111 BEE RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34239-6104
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Country | US
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Telephone | 941-792-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 162264
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-2264
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Country | US
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Telephone | 941-792-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1594
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 1594
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License Number State | NE
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