Individual
MR. KIM G COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
202 LAKE MIRIAM DR STE S1, LAKELAND, FL 33813-2188
(863) 647-2333
(863) 393-1995
Mailing address
202 LAKE MIRIAM DR STE S1, LAKELAND, FL 33813-2188
(863) 647-2333
(863) 644-6729
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 2993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10679201
CITRUS HEALTHCARE
FL
01
—
PA2993
STATE LICENSE
FL
Enumeration date
11/10/2005
Last updated
04/20/2011
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