Provider Demographics
NPI:1467486662
Name:MANNING-MAESTAS, KIMBERLEE ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:MANNING-MAESTAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:KIMBERLEE
Other - Middle Name:ANN
Other - Last Name:MANNING-MAYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-319-1003
Practice Address - Street 1:10000 BAY PINES BLVD SUITE 112
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:505-262-7371
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22106367Medicaid