Provider Demographics
NPI:1164239612
Name:DAMMS, KEVIN ANDREW (LPN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANDREW
Last Name:DAMMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 NW 71ST CT STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2930
Mailing Address - Country:US
Mailing Address - Phone:954-495-4020
Mailing Address - Fax:
Practice Address - Street 1:7710 NW 71ST CT STE 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2930
Practice Address - Country:US
Practice Address - Phone:954-495-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5226552164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse