Healthcare Provider Details

I. General information

NPI: 1215133202
Provider Name (Legal Business Name): CARYL KIPP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE ROAD #204
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

1 W SAMPLE ROAD #204
POMPANO BEACH FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-0300
  • Fax: 954-785-0229
Mailing address:
  • Phone: 954-785-0300
  • Fax: 954-785-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPA2429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: