Healthcare Provider Details

I. General information

NPI: 1528489036
Provider Name (Legal Business Name): KIMBERLY A MAKUTA-MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

12479 JAYBIRD RD
WEEKI WACHEE FL
34614-3293
US

V. Phone/Fax

Practice location:
  • Phone: 813-830-1103
  • Fax:
Mailing address:
  • Phone: 570-293-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11018838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN597893
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: