Provider Demographics
NPI:1013674423
Name:ALTMAN, KYLIE JEAN
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:JEAN
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20764 NW 166TH PL
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-7781
Mailing Address - Country:US
Mailing Address - Phone:954-245-2840
Mailing Address - Fax:
Practice Address - Street 1:20764 NW 166TH PL
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-7781
Practice Address - Country:US
Practice Address - Phone:954-245-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily