Basic Information
| Provider Information | |||||||||
| NPI: | 1316002249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINDER | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 W ALEXANDER ST | ||||||||
| Address2: | PMB # 387 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137547756 | ||||||||
| FaxNumber: | 8137547565 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 S FLORIDA ST | ||||||||
| Address2: | |||||||||
| City: | BUSHNELL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335136703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527932441 | ||||||||
| FaxNumber: | 3527933282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 03/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP3204652 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 660209600 | 01 | FL | MEDICAID GROUP NUMBER | OTHER | Y6709 | 01 | FL | BCBS | OTHER | 302165300 | 05 | FL | MEDICAID | 35207U | 01 | FL | MEDICARE GROUP NUMBER | OTHER | 500008032 | 01 | FL | MEDICARE RAILROAD | OTHER |