Provider Demographics
NPI:1003352956
Name:STANFORD, KIMBERKY (RN, BSBA, QMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERKY
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:RN, BSBA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 CROTON AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4907
Mailing Address - Country:US
Mailing Address - Phone:941-960-3222
Mailing Address - Fax:
Practice Address - Street 1:2512 CROTON AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4907
Practice Address - Country:US
Practice Address - Phone:941-960-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility