Provider Demographics
NPI:1174505101
Name:DUMAS, KIMALYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMALYN
Middle Name:
Last Name:DUMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:6128 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4029
Practice Address - Country:US
Practice Address - Phone:941-923-5882
Practice Address - Fax:941-923-3836
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1077063163WG0000X
FLARNP9422997363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33181OtherBCBS
AL051552833Medicaid
AL51515022OtherBCBS OF AL
ALP73687Medicare UPIN