Provider Demographics
NPI:1649253139
Name:WESTBROOK, KIMBERLY S (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:WESTBROOK
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 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:12083 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7350
Practice Address - Country:US
Practice Address - Phone:352-596-4022
Practice Address - Fax:352-596-9851
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9205564363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269859500OtherMEDICAID GRP
FL000059500Medicaid
FLARNP9205564OtherSTATE LICENSE NUMBER
FLP00294613OtherMEDICARE RR
FLCF1412OtherMEDICARD RR GRP
FL77940OtherMEDICARE GRP
FLARNP9205564OtherSTATE LICENSE NUMBER
FL269859500OtherMEDICAID GRP