Provider Demographics
NPI:1659648756
Name:GUNN, KIMBERLY K (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:GUNN
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 1:13475 SOUTHERN BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13475 SOUTHERN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9203
Practice Address - Country:US
Practice Address - Phone:561-333-5022
Practice Address - Fax:561-333-0449
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9309546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily