Healthcare Provider Details

I. General information

NPI: 1700820958
Provider Name (Legal Business Name): KIMBERLY A SAND ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 53RD AVE E BUILDING A
BRADENTON FL
34203-4897
US

IV. Provider business mailing address

1105 53RD AVE E STE A
BRADENTON FL
34203-4897
US

V. Phone/Fax

Practice location:
  • Phone: 941-755-2562
  • Fax: 941-758-4065
Mailing address:
  • Phone: 941-708-3358
  • Fax: 941-758-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9190096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: