Provider Demographics
NPI:1861662728
Name:KIMMERLE, M LINDA (RN BSN MPM CCM)
Entity Type:Individual
Prefix:
First Name:M LINDA
Middle Name:
Last Name:KIMMERLE
Suffix:
Gender:F
Credentials:RN BSN MPM CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 HAZELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-1216
Mailing Address - Country:US
Mailing Address - Phone:352-597-2425
Mailing Address - Fax:
Practice Address - Street 1:6403 HAZELWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-1216
Practice Address - Country:US
Practice Address - Phone:352-597-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9187293163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management