Provider Demographics
NPI:1073057618
Name:POTTER, KYMBERLEE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KYMBERLEE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KYMBERLEE
Other - Middle Name:
Other - Last Name:COFFINDAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5401 S CONGRESS AVE
Mailing Address - Street 2:STE # 204
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6635
Mailing Address - Country:US
Mailing Address - Phone:561-967-4118
Mailing Address - Fax:561-967-3463
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:STE # 204
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-967-4118
Practice Address - Fax:561-967-3463
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily