1316002249 NPI number — ELAINE I KINDER ARNP

Table of content: ELAINE I KINDER ARNP (NPI 1316002249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316002249 NPI number — ELAINE I KINDER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINDER
Provider First Name:
ELAINE
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316002249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 W ALEXANDER ST
Provider Second Line Business Mailing Address:
PMB # 387
Provider Business Mailing Address City Name:
PLANT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-754-7756
Provider Business Mailing Address Fax Number:
813-754-7565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S FLORIDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUSHNELL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33513-6703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-793-2441
Provider Business Practice Location Address Fax Number:
352-793-3282
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP3204652 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 660209600 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y6709 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 302165300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35207U . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 500008032 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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