Healthcare Provider Details

I. General information

NPI: 1861320095
Provider Name (Legal Business Name): KIMBERLY DANA HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12719 SW 27TH ST
MIRAMAR FL
33027-3822
US

IV. Provider business mailing address

12719 SW 27TH ST
MIRAMAR FL
33027-3822
US

V. Phone/Fax

Practice location:
  • Phone: 786-246-5299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11011062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: