Provider Demographics
NPI:1316002249
Name:KINDER, ELAINE I (ARNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:I
Last Name:KINDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W ALEXANDER ST
Mailing Address - Street 2:PMB # 387
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563
Mailing Address - Country:US
Mailing Address - Phone:813-754-7756
Mailing Address - Fax:813-754-7565
Practice Address - Street 1:212 S FLORIDA ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6703
Practice Address - Country:US
Practice Address - Phone:352-793-2441
Practice Address - Fax:352-793-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3204652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660209600OtherMEDICAID GROUP NUMBER
FLY6709OtherBCBS
FL302165300Medicaid
FL35207UOtherMEDICARE GROUP NUMBER
FL500008032OtherMEDICARE RAILROAD
FL302165300Medicaid
S49479Medicare UPIN