Provider Demographics
NPI:1528625308
Name:ASCANIO, KALIMA VICTORIA
Entity type:Individual
Prefix:
First Name:KALIMA
Middle Name:VICTORIA
Last Name:ASCANIO
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 1:10901 SW 242ND ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5141
Mailing Address - Country:US
Mailing Address - Phone:786-397-4529
Mailing Address - Fax:
Practice Address - Street 1:10901 SW 242ND ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5141
Practice Address - Country:US
Practice Address - Phone:786-397-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily