Healthcare Provider Details

I. General information

NPI: 1437068251
Provider Name (Legal Business Name): KIMBERLY JEAN ROXBURY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

IV. Provider business mailing address

154 SANDALWOOD WAY
LONGWOOD FL
32750-2918
US

V. Phone/Fax

Practice location:
  • Phone: 407-743-5089
  • Fax:
Mailing address:
  • Phone: 407-743-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11048744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: