MEDICARE: NARDRIA R KUNKEL MSW

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	1041C0700X	Clinical Social Worker	ISW17524	FL

General Provider Information

NPI Number	:	1679338784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARDRIA R KUNKEL MSW

Provider Business Mailing Address
First Line	:	7821 49TH AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-7971
Country	:	US
Telephone Number	:	954-907-0435
Fax Number	:

Provider Business Practice Location Address
First Line	:	3592 BROADWAY STE 110
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8056
Country	:	US
Telephone Number	:	954-907-0435
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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