Provider Demographics
NPI:1972804276
Name:SAMPLE, KIMBERLY (RNFA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TABIT RD
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4556
Mailing Address - Country:US
Mailing Address - Phone:561-755-3299
Mailing Address - Fax:
Practice Address - Street 1:39200 HOOKER HWY
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-5368
Practice Address - Country:US
Practice Address - Phone:561-755-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2960732163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant