Healthcare Provider Details

I. General information

NPI: 1316980436
Provider Name (Legal Business Name): KIMBERLY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 N RIDGEWOOD AVE
EDGEWATER FL
32132-1618
US

IV. Provider business mailing address

328 N RIDGEWOOD AVE
EDGEWATER FL
32132-1618
US

V. Phone/Fax

Practice location:
  • Phone: 386-409-8828
  • Fax: 386-409-8829
Mailing address:
  • Phone: 386-409-8828
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS1942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: