Provider Demographics
NPI:1952630451
Name:EADIE, KIMBERLY DARLENE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DARLENE
Last Name:EADIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 FAWN MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5331
Mailing Address - Country:US
Mailing Address - Phone:248-494-0014
Mailing Address - Fax:
Practice Address - Street 1:10101 W COLONIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4213
Practice Address - Country:US
Practice Address - Phone:407-895-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7565363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care