MEDICARE: M LINDA KIMMERLE RN BSN MPM CCM

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	163WC0400X	Case Management Registered Nurse	RN9187293	FL

General Provider Information

NPI Number	:	1861662728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M LINDA KIMMERLE RN BSN MPM CCM

Provider Business Mailing Address
First Line	:	6403 HAZELWOOD RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-1216
Country	:	US
Telephone Number	:	352-597-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	6403 HAZELWOOD RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-1216
Country	:	US
Telephone Number	:	352-597-2425
Fax Number	:

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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