Provider Demographics
NPI:1598656506
Name:KUCK, CHAIMA (APRN)
Entity type:Individual
Prefix:
First Name:CHAIMA
Middle Name:
Last Name:KUCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHAIMA
Other - Middle Name:
Other - Last Name:EL FSSAYLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 HARLEYFORD PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-7303
Mailing Address - Country:US
Mailing Address - Phone:813-703-3007
Mailing Address - Fax:
Practice Address - Street 1:2425 HARLEYFORD PL
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-7303
Practice Address - Country:US
Practice Address - Phone:813-703-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily