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General NPI Number Information
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NPI Number | 1609508365
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Entity Type | Individual
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Provider Name | KETHTIA CIMEUS APRN
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 4475 MEDICAL CENTER WAY STE 3
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3240
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Country | US
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Telephone | 561-781-8070
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Fax | 561-781-8077
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Provider Business Mailing Address
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Address Line | PO BOX 4189
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-4189
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Country | US
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Telephone | 954-363-9582
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Fax | 954-363-9663
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11014698
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License Number State | FL
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