Individual
MR. IVAN KIRK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1604 FLUORSHIRE DR, BRANDON, FL 33511-9393
(813) 746-4619
Mailing address
1604 FLUORSHIRE DR, BRANDON, FL 33511-9393
(813) 746-4619
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5179474
FL
Other
Enumeration date
11/27/2007
Last updated
11/27/2007
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