Provider Demographics
NPI:1821013749
Name:KIMBLE, CYNTHIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4417
Mailing Address - Country:US
Mailing Address - Phone:850-877-4744
Mailing Address - Fax:840-383-0501
Practice Address - Street 1:2451 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4417
Practice Address - Country:US
Practice Address - Phone:850-877-4744
Practice Address - Fax:840-383-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263551800Medicaid
FL263551800Medicaid
FL18756Medicare ID - Type Unspecified