Healthcare Provider Details

I. General information

NPI: 1003142373
Provider Name (Legal Business Name): KIMBERLY A VERBARG L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LITHIA PINECREST RD
BRANDON FL
33511
US

IV. Provider business mailing address

215 LITHIA PINECREST RD
BRANDON FL
33511-5307
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-8404
  • Fax: 813-298-0620
Mailing address:
  • Phone: 813-685-8404
  • Fax: 813-298-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: