Individual
KIMBERLY DRAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1112 W 12TH ST, LAKELAND, FL 33805-3465
(863) 838-4042
Mailing address
3617 FRONTAGE RD N, LAKELAND, FL 33810-2891
(863) 838-4042
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019404200
—
FL
Enumeration date
07/15/2017
Last updated
07/15/2017
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