Provider Demographics
NPI:1508375189
Name:BERNAL, KIMBERLY (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2350 SUNSET POINT RD STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-797-3155
Practice Address - Fax:727-797-4301
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNOP.021776363L00000X
FLAPRN9487876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100579900Medicaid
OHF08171203Medicaid