Individual
KIMBERLY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNFA
Contact information
Practice address
12880 COMMODITY PL, TAMPA, FL 33626-3101
(813) 865-1340
(813) 343-5506
Mailing address
PO BOX 21724, TAMPA, FL 33622-1724
(813) 865-1340
(813) 343-5506
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
0001144095
VA
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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