MEDICARE: KYLIE GROSS

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	163W00000X	Registered Nurse	9385034	FL

General Provider Information

NPI Number	:	1689286783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE GROSS

Provider Business Mailing Address
First Line	:	9357 SW 77TH AVE APT 108
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-3164
Country	:	US
Telephone Number	:	305-519-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NW 168TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-6045
Country	:	US
Telephone Number	:	786-418-0620
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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