MEDICARE: MS. KIMBERLEY JOYCE PHILIP APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN2100132	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538130919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEY JOYCE PHILIP APRN

Provider Business Mailing Address
First Line	:	13123 66TH ST
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-1812
Country	:	US
Telephone Number	:	727-213-5808
Fax Number	:	727-477-0498

Provider Business Practice Location Address
First Line	:	13123 66TH ST
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-1812
Country	:	US
Telephone Number	:	727-213-5808
Fax Number	:	727-477-0498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/01/2022

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