Provider Demographics
NPI:1598868481
Name:GRAY, KIMBERLY P (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:GRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 NW 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-1858
Mailing Address - Country:US
Mailing Address - Phone:352-376-1887
Mailing Address - Fax:352-375-7451
Practice Address - Street 1:2521 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6630
Practice Address - Country:US
Practice Address - Phone:352-377-7733
Practice Address - Fax:352-377-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3317612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2402OtherBCBS
FLG2402OtherBCBS