Provider Demographics
NPI:1124387402
Name:ANGEL, KIMBERLEE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:
Last Name:ANGEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 W BELL RD STE 121
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9333
Mailing Address - Country:US
Mailing Address - Phone:623-444-2123
Mailing Address - Fax:
Practice Address - Street 1:11340 W BELL RD STE 121
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9333
Practice Address - Country:US
Practice Address - Phone:623-444-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN142830163WE0003X
AZ300128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEMP300128OtherARIZONA BOARD OF NURSING