Provider Demographics
NPI:1114469970
Name:KEIM, KAROL (LPN)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:
Last Name:KEIM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 STARLIGHT POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-4519
Mailing Address - Country:US
Mailing Address - Phone:863-327-9472
Mailing Address - Fax:
Practice Address - Street 1:4416 STARLIGHT POINTE DR
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-4519
Practice Address - Country:US
Practice Address - Phone:863-327-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5197436164W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide