Provider Demographics
NPI:1215133202
Name:KIPP, CARYL (PA)
Entity type:Individual
Prefix:
First Name:CARYL
Middle Name:
Last Name:KIPP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W SAMPLE ROAD
Mailing Address - Street 2:#204
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-785-0300
Mailing Address - Fax:954-785-0229
Practice Address - Street 1:1 W SAMPLE ROAD
Practice Address - Street 2:#204
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-785-0300
Practice Address - Fax:954-785-0229
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2429207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease