Provider Demographics
NPI:1598968257
Name:SANFILIPPO, KIMBERLY A (RT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KASHGAR CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5699
Mailing Address - Country:US
Mailing Address - Phone:386-313-3453
Mailing Address - Fax:
Practice Address - Street 1:4721 E MOODY BLVD
Practice Address - Street 2:BLDG 1 STE 103
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7705
Practice Address - Country:US
Practice Address - Phone:386-586-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT5834227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTT5834OtherSTATE LICENSE