Provider Demographics
NPI:1538130919
Name:PHILIP, KIMBERLEY JOYCE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:JOYCE
Last Name:PHILIP
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 1:13123 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1812
Mailing Address - Country:US
Mailing Address - Phone:727-213-5808
Mailing Address - Fax:727-477-0498
Practice Address - Street 1:13123 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1812
Practice Address - Country:US
Practice Address - Phone:727-213-5808
Practice Address - Fax:727-477-0498
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2100132363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE85804Medicare PIN
FLP74271Medicare UPIN