Provider Demographics
NPI:1093181497
Name:BURNAM, KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BURNAM
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 1:461 W OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6624
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:407-846-2301
Practice Address - Street 1:461 W OAK ST STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6624
Practice Address - Country:US
Practice Address - Phone:407-846-8600
Practice Address - Fax:407-846-2301
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9246734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018266400Medicaid
FLIT812ZMedicare PIN