Individual
SOPHIA KIBUISMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4811 5TH AVE S, ST PETERSBURG, FL 33711-1421
(425) 246-5077
Mailing address
4811 5TH AVE S, ST PETERSBURG, FL 33711-1421
(425) 246-5077
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6907085
FL
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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