Provider Demographics
NPI:1477034601
Name:KIMBLE, TIFFANY CHRISTINE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHRISTINE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:APRN, 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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:941-799-5603
Mailing Address - Fax:
Practice Address - Street 1:3630 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2557
Practice Address - Country:US
Practice Address - Phone:941-792-1881
Practice Address - Fax:941-795-3924
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000026363LF0000X
FLAPRN11000026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110667900Medicaid