Healthcare Provider Details

I. General information

NPI: 1720676703
Provider Name (Legal Business Name): KIMBERLY CLAIRE BORRELLI HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 W LINEBAUGH AVE STE 101
TAMPA FL
33625-5830
US

IV. Provider business mailing address

12028 CITRUS FALLS CIR APT 208
TAMPA FL
33625-5725
US

V. Phone/Fax

Practice location:
  • Phone: 813-962-1888
  • Fax: 813-369-5337
Mailing address:
  • Phone: 803-645-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: