Provider Demographics
NPI:1558390013
Name:HUGHES, KIMBERLEY LOUISE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:LOUISE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-332-8080
Mailing Address - Fax:
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 210
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-332-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2055072363L00000X
FL2055072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2248WMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
FLK2836Medicare ID - Type UnspecifiedMEDICARE GRP #