Provider Demographics
NPI:1124387402
Name:ANGEL, KIMBERLEE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:
Last Name:ANGEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 W. BELL RD
Mailing Address - Street 2:SUITE 101, #134
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:602-799-2766
Mailing Address - Fax:
Practice Address - Street 1:14985 W BELL RD BLDG 12-A
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3231
Practice Address - Country:US
Practice Address - Phone:623-666-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN142830163WE0003X
AZTEMP300128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEMP300128OtherARIZONA BOARD OF NURSING