Healthcare Provider Details

I. General information

NPI: 1811695778
Provider Name (Legal Business Name): KIM HO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

IV. Provider business mailing address

1306 DITTMER CIR SE
PALM BAY FL
32909-1326
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-3162
  • Fax: 321-821-4955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11024461
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: