Provider Demographics
NPI:1750355608
Name:NOTTINGHAM, KIMBERLEE S (CRNA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:S
Last Name:NOTTINGHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KIMBERLEE
Other - Middle Name:S
Other - Last Name:NOTTINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1256 GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3201
Mailing Address - Country:US
Mailing Address - Phone:239-450-3783
Mailing Address - Fax:800-521-9318
Practice Address - Street 1:1256 GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3201
Practice Address - Country:US
Practice Address - Phone:239-450-3783
Practice Address - Fax:800-521-9318
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2789312367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430054281OtherRAILROAD MEDICARE
FLG1938OtherBC/BS FL
188602470OtherCHAMPUS
FL304445900Medicaid
591783920OtherEIN
FL304445900Medicaid