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General NPI Number Information
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NPI Number | 1164319083
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Entity Type | Individual
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Provider Name | KIMBERLI FANUCCI
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Gender | Female
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 4701 SW COLLEGE RD STE 107
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City | OCALA
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State | FL
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Zip | 34474-4739
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Country | US
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Telephone | 352-291-0728
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Fax |
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Provider Business Mailing Address
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Address Line | 4240 SW 58TH AVE
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City | OCALA
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State | FL
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Zip | 34474-9538
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Country | US
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Telephone | 352-342-7768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CL1176537
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License Number State | FL
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