Healthcare Provider Details

I. General information

NPI: 1023029386
Provider Name (Legal Business Name): KIMBERLY A HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 LAWTON RD SUITE 100
ORLANDO FL
32803-3531
US

IV. Provider business mailing address

3113 LAWTON RD SUITE 100
ORLANDO FL
32803-3531
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-3241
  • Fax: 407-896-9863
Mailing address:
  • Phone: 407-894-3241
  • Fax: 407-896-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1887152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: