Provider Demographics
NPI:1598430068
Name:INSALACO, KIMBERLY KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATHLEEN
Last Name:INSALACO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 E LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0820
Mailing Address - Country:US
Mailing Address - Phone:714-414-6728
Mailing Address - Fax:
Practice Address - Street 1:1881 E LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0820
Practice Address - Country:US
Practice Address - Phone:714-414-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily