Provider Demographics
NPI:1396055836
Name:PACETTI, KIMBERLY ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:PACETTI
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 1:419 ANASTASIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4508
Mailing Address - Country:US
Mailing Address - Phone:904-824-8353
Mailing Address - Fax:
Practice Address - Street 1:419 ANASTASIA BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4508
Practice Address - Country:US
Practice Address - Phone:904-824-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily