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General NPI Number Information
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NPI Number | 1558970277
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Entity Type | Individual
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Provider Name | KIMBERLY GAYLE ROSS NP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2113 SARNO RD
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City | MELBOURNE
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State | FL
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Zip | 32935-3001
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Country | US
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Telephone | 321-676-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 W EAU GALLIE BLVD
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City | MELBOURNE
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State | FL
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Zip | 32934-7213
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Country | US
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Telephone | 321-751-6671
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11008351
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License Number State | FL
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