Healthcare Provider Details

I. General information

NPI: 1952394231
Provider Name (Legal Business Name): KIMBERLY S LANG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 26TH AVE E
BRADENTON FL
34208-7707
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-8600
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax: 954-967-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN1895682
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1895682
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN1895682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: