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General NPI Number Information
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NPI Number | 1992755714
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE IFILL PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 1309 N. FLASLER DR.
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 786-218-0963
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Fax | 561-253-9175
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Provider Business Mailing Address
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Address Line | 110 S K ST #3
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33460
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Country | US
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Telephone | 786-218-0963
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Fax | 561-253-9175
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102435
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License Number State | FL
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