Healthcare Provider Details

I. General information

NPI: 1669203915
Provider Name (Legal Business Name): KIMBERLY M AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-9848
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-300-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9119830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: