MEDICARE: MRS. BONNIE LOU KOKAL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP1029722	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G0364	OTHER	FL	BC/BS OF FLORIDA

General Provider Information

NPI Number	:	1588658306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE LOU KOKAL CRNA

Provider Business Mailing Address
First Line	:	3552 STUART CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7737
Country	:	US
Telephone Number	:	239-332-5909
Fax Number	:

Provider Business Practice Location Address
First Line	:	15620 NEW HAMPSHIRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4168
Country	:	US
Telephone Number	:	239-481-9995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	02/29/2008

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