Healthcare Provider Details

I. General information

NPI: 1518677640
Provider Name (Legal Business Name): KIMBERLY GRAHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 SW COLLEGE RD
OCALA FL
34474-4441
US

IV. Provider business mailing address

69 ANN LEE LN
TAMARAC FL
33319-2462
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-8401
  • Fax:
Mailing address:
  • Phone: 954-348-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11022082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: