Provider Demographics
NPI:1700820958
Name:SAND, KIMBERLY A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:SAND
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 1:1105 53RD AVE E STE A
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4897
Mailing Address - Country:US
Mailing Address - Phone:941-708-3358
Mailing Address - Fax:941-758-4065
Practice Address - Street 1:1105 53RD AVE E
Practice Address - Street 2:BUILDING A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4897
Practice Address - Country:US
Practice Address - Phone:941-755-2562
Practice Address - Fax:941-758-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9190096363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9190096OtherSTATE MEDICAL LICENSE
FLP00213322OtherRAILROAD MEDICARE
FLP00213322OtherRAILROAD MEDICARE
Q19377Medicare UPIN