Provider Demographics
NPI:1487395828
Name:MUNIZ GONZALEZ, KISLAINE DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:KISLAINE
Middle Name:DE LA CARIDAD
Last Name:MUNIZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 HICKORY CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1440
Mailing Address - Country:US
Mailing Address - Phone:786-260-7574
Mailing Address - Fax:
Practice Address - Street 1:7820 N ARMENIA AVE STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3852
Practice Address - Country:US
Practice Address - Phone:813-935-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner