Provider Demographics
NPI:1760637201
Name:CAVANAUGH, KIMBERLEE ANN (ARNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ANN
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N SYKES CREEK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3488
Mailing Address - Country:US
Mailing Address - Phone:321-449-4572
Mailing Address - Fax:321-449-4164
Practice Address - Street 1:1500 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2612
Practice Address - Country:US
Practice Address - Phone:321-452-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2686042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily