Provider Demographics
NPI:1013183938
Name:KIMBERLY VAN SCRIVER MD PA
Entity Type:Organization
Organization Name:KIMBERLY VAN SCRIVER MD PA
Other - Org Name:A PLACE FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN SCRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-674-0022
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-674-0022
Mailing Address - Fax:904-425-0192
Practice Address - Street 1:6817 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 2204
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6282
Practice Address - Country:US
Practice Address - Phone:904-674-0022
Practice Address - Fax:904-425-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73993207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386658144OtherNPI
FL1477625457OtherNPI
FL1205898517OtherNPI