Healthcare Provider Details

I. General information

NPI: 1366646804
Provider Name (Legal Business Name): KIMBERLY JENNIFER HULL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY JENNIFER MAY

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N UNIVERSITY DR SUITE K
CORAL SPRINGS FL
33065-5055
US

IV. Provider business mailing address

3000 N UNIVERSITY DR SUITE K
CORAL SPRINGS FL
33065-5055
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-2630
  • Fax: 954-755-1865
Mailing address:
  • Phone: 954-752-2630
  • Fax: 954-755-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS11414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: