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General NPI Number Information
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NPI Number | 1477169662
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Entity Type | Individual
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Provider Name | BOBBY JOE NEAL KIMBRO FNP-C
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Gender | Male
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 315 DANIEL TRENT WAY
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City | KINGSLAND
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State | GA
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Zip | 31548-6098
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Country | US
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Telephone | 912-409-5568
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11009094
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License Number State | FL
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