Provider Demographics
NPI:1245527993
Name:GAMBINO, KIMBERLY MARIE (APRN, RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:TESTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:236 BOSTON POST ROAD
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 BOSTON POST ROAD
Practice Address - Street 2:UNIT 1A
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3236
Practice Address - Country:US
Practice Address - Phone:475-882-6824
Practice Address - Fax:203-693-2320
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83287163W00000X
CT4689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008057180Medicaid
CTD400084140Medicare Oscar/Certification