Provider Demographics
NPI:1124989686
Name:MARINO-MICHEEL, KIMBERLY (DOM,LAC,AP,DIPL,RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MARINO-MICHEEL
Suffix:
Gender:F
Credentials:DOM,LAC,AP,DIPL,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 FORKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1710
Mailing Address - Country:US
Mailing Address - Phone:941-812-0777
Mailing Address - Fax:
Practice Address - Street 1:630 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-2728
Practice Address - Country:US
Practice Address - Phone:941-812-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-22
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL.AC4693202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty