Active NPI
Kim Phung Tran-Bardell
- Social Worker
- Tavares, FL
National Provider Identifier
1285064741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- ISW 6247
- Practice address
- 2118 Tealwood Cir
Tavares, FL 32778-9335 - Phone
- (352) 729-3689
- NPI assigned
- Nov 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | ISW 6247 | FL | Primary |
Addresses
Primary practice location
2118 Tealwood Cir
Tavares, FL 32778-9335
Mailing address
2118 Tealwood Cir
Tavares, FL 32778-9335
Phone (352) 729-3689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ISW 6247 | FL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384905600000",
"number": "1285064741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2118 TEALWOOD CIR",
"city": "TAVARES",
"state": "FL",
"postal_code": "327789335",
"telephone_number": "352-729-3689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2118 TEALWOOD CIR",
"city": "TAVARES",
"state": "FL",
"postal_code": "327789335",
"telephone_number": "352-729-3689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAN-BARDELL",
"first_name": "KIM",
"middle_name": "PHUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-20",
"last_updated": "2013-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "FL",
"license": "ISW 6247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.