Provider Demographics
NPI:1972223212
Name:LEE, KIMBERLEY SUE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 36TH AVENUE CIR W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-6034
Mailing Address - Country:US
Mailing Address - Phone:941-545-4847
Mailing Address - Fax:
Practice Address - Street 1:2198 MAIN ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6024
Practice Address - Country:US
Practice Address - Phone:941-315-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021220207Q00000X
FLAPRN11021220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine