Healthcare Provider Details

I. General information

NPI: 1932019767
Provider Name (Legal Business Name): KIMARIE VHENISHA WILSON SPENCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

33637 SKY BLOSSOM CIR
LEESBURG FL
34788-3327
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2346
  • Fax:
Mailing address:
  • Phone: 984-269-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11047313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: