Healthcare Provider Details

I. General information

NPI: 1306247176
Provider Name (Legal Business Name): KIMBERLY COUSINS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

52 W UNDERWOOD ST MP 153
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8475
  • Fax: 407-849-6470
Mailing address:
  • Phone: 321-841-2558
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9325308
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9325308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: