MEDICARE: KIMBERLY KEECH FNP-BC, 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	363LF0000X	Family Nurse Practitioner	11008652	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11008652	OTHER	FL	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1770190530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KEECH FNP-BC, APRN

Provider Business Mailing Address
First Line	:	400 FRANDORSON CIR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2688
Country	:	US
Telephone Number	:	813-790-5887
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FRANDORSON CIR STE 4110
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2645
Country	:	US
Telephone Number	:	813-790-5887
Fax Number	:	915-200-0054

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	04/06/2026

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