Provider Demographics
NPI:1063421063
Name:GEIB, KIMBERLY GAYLE (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GAYLE
Last Name:GEIB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0517
Mailing Address - Country:US
Mailing Address - Phone:904-548-1800
Mailing Address - Fax:904-277-7286
Practice Address - Street 1:1620 NECTARINE ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4724
Practice Address - Country:US
Practice Address - Phone:904-548-1860
Practice Address - Fax:904-277-7283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1121982363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304015100Medicaid
FLE7342ZMedicare PIN
FL304015100Medicaid