Provider Demographics
NPI:1285283143
Name:ALLYN, KIMBERLY N (BSN, RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:ALLYN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 NE 33RD CT APT 402
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-2042
Mailing Address - Country:US
Mailing Address - Phone:954-684-3682
Mailing Address - Fax:
Practice Address - Street 1:1940 NE 55TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3151
Practice Address - Country:US
Practice Address - Phone:954-684-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
FL9267299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider