Healthcare Provider Details

I. General information

NPI: 1073057618
Provider Name (Legal Business Name): KYMBERLEE POTTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYMBERLEE COFFINDAFFER

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JOHN F KENNEDY DR STE 250
ATLANTIS FL
33462-6642
US

IV. Provider business mailing address

PO BOX 22239
NEW YORK NY
10087-0001
US

V. Phone/Fax

Practice location:
  • Phone: 561-969-1777
  • Fax: 561-969-3621
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9203644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: