MEDICARE: KIMBERLEE MCCARREN

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	124Q00000X	Dental Hygienist	DH21236	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DH21236	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1912350604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE MCCARREN

Provider Business Mailing Address
First Line	:	3032 TONKIN DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-4301
Country	:	US
Telephone Number	:	941-525-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	3032 TONKIN DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-4301
Country	:	US
Telephone Number	:	941-525-7994
Fax Number	:

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

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “ KIMBERLEE MCCARREN ” Practice Location

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