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General NPI Number Information
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NPI Number | 1700571395
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Entity Type | Individual
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Provider Name | KIM AN PHAM
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 106 BOSTON AVE STE 100
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4712
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Country | US
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Telephone | 800-827-7546
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Fax | 407-499-3665
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Provider Business Mailing Address
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Address Line | 106 BOSTON AVE STE 100
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4712
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Country | US
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Telephone | 800-827-7546
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Fax | 407-499-3665
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9535823
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 5018197
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5018197
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License Number State | NC
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