Provider Demographics
NPI:1255195749
Name:A KUT ABOVE MOBILE MEDICAL INC
Entity type:Organization
Organization Name:A KUT ABOVE MOBILE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:321-720-5905
Mailing Address - Street 1:1900 S HARBOR CITY BLVD STE 232
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4789
Mailing Address - Country:US
Mailing Address - Phone:321-216-2288
Mailing Address - Fax:321-216-2255
Practice Address - Street 1:1900 S HARBOR CITY BLVD STE 232
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4789
Practice Address - Country:US
Practice Address - Phone:321-216-2288
Practice Address - Fax:321-216-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty