Basic Information
| Provider Information | |||||||||
| NPI: | 1649253139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTBROOK | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 12083 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346137350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525964022 | ||||||||
| FaxNumber: | 3525969851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9205564 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | ARNP9205564 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P00294613 | 01 | FL | MEDICARE RR | OTHER | 77940 | 01 | FL | MEDICARE GRP | OTHER | 269859500 | 01 | FL | MEDICAID GRP | OTHER | CF1412 | 01 | FL | MEDICARD RR GRP | OTHER | ARNP9205564 | 01 | FL | STATE LICENSE NUMBER | OTHER | 000059500 | 05 | FL | MEDICAID |