Healthcare Provider Details

I. General information

NPI: 1225890031
Provider Name (Legal Business Name): KIMBERLY L ASHRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 TROPIC PARK DR STE 1590
SANFORD FL
32773-6323
US

IV. Provider business mailing address

1335 PHILLIPS ST
DAYTONA BEACH FL
32114-2315
US

V. Phone/Fax

Practice location:
  • Phone: 859-552-0338
  • Fax:
Mailing address:
  • Phone: 859-552-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: