Provider Demographics
NPI:1851617518
Name:CROSSE, KIMBERLY N (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:N
Last Name:CROSSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:N
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1400 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1003
Mailing Address - Country:US
Mailing Address - Phone:305-689-5376
Mailing Address - Fax:305-689-3990
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-689-5376
Practice Address - Fax:305-689-3990
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233694367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered