Provider Demographics
NPI:1518214402
Name:PIGNINELLI, KIMBERLY DEBRA (BS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DEBRA
Last Name:PIGNINELLI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:DEBRA
Other - Last Name:COURCHAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3314
Mailing Address - Country:US
Mailing Address - Phone:386-944-4707
Mailing Address - Fax:
Practice Address - Street 1:65 LARAMIE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9623
Practice Address - Country:US
Practice Address - Phone:386-627-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator