Healthcare Provider Details

I. General information

NPI: 1588658819
Provider Name (Legal Business Name): NANDINI KIRI MD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD STE A
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD STE A
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax: 863-940-4856
Mailing address:
  • Phone: 863-816-5884
  • Fax: 863-940-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: