Provider Demographics
NPI:1508576398
Name:BOONMAST, KIMBER ANN (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:ANN
Last Name:BOONMAST
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 1:16608 N SHORE CV
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8326
Mailing Address - Country:US
Mailing Address - Phone:386-837-1060
Mailing Address - Fax:
Practice Address - Street 1:12385 SORRENTO RD STE A4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8656
Practice Address - Country:US
Practice Address - Phone:850-602-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily