MEDICARE: JOSEPH THOMAS KINNEY

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	163WG0000X	General Practice Registered Nurse	9238803	FL

General Provider Information

NPI Number	:	1568059897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH THOMAS KINNEY

Provider Business Mailing Address
First Line	:	4628 MESSINA DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2642
Country	:	US
Telephone Number	:	407-256-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4628 MESSINA DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2642
Country	:	US
Telephone Number	:	407-256-3115
Fax Number	:

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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