Provider Demographics
NPI:1215913561
Name:BRASWELL, KIMBERLY DAVIS (ARNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAVIS
Last Name:BRASWELL
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 1:16233 NOTTINGHAM PARK WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2769
Mailing Address - Country:US
Mailing Address - Phone:813-361-3653
Mailing Address - Fax:
Practice Address - Street 1:2111 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2477
Practice Address - Country:US
Practice Address - Phone:813-254-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3204832363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP15013Medicare UPIN
FLY9424YMedicare ID - Type Unspecified