Healthcare Provider Details

I. General information

NPI: 1639790371
Provider Name (Legal Business Name): KIMBERLY TRISHELLE WESTON APN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 OLD GROVE CIR
BRADENTON FL
34212-2605
US

IV. Provider business mailing address

10730 OLD GROVE CIR
BRADENTON FL
34212-2605
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-1364
  • Fax:
Mailing address:
  • Phone: 813-997-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0004688-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: