Basic Information
| Provider Information | |||||||||
| NPI: | 1700820958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAND | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 53RD AVE E STE A | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342034897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417083358 | ||||||||
| FaxNumber: | 9417584065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 53RD AVE E | ||||||||
| Address2: | BUILDING A | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342034897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417552562 | ||||||||
| FaxNumber: | 9417584065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 9190096 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | ARNP9190096 | 01 | FL | STATE MEDICAL LICENSE | OTHER | P00213322 | 01 | FL | RAILROAD MEDICARE | OTHER |