Provider Demographics
NPI:1235692716
Name:KIKLEVICH, KAMOI (APRN)
Entity Type:Individual
Prefix:
First Name:KAMOI
Middle Name:
Last Name:KIKLEVICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7552 STIRLING RD APT 112
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1555
Mailing Address - Country:US
Mailing Address - Phone:786-624-9315
Mailing Address - Fax:
Practice Address - Street 1:3090 N COURSE DR APT 612
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3327
Practice Address - Country:US
Practice Address - Phone:786-624-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily