Healthcare Provider Details

I. General information

NPI: 1033408745
Provider Name (Legal Business Name): KIMBERLY LAJUAN REDMOND MSN, CPNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

89 W COPELAND DR
ORLANDO FL
32891-2002
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-4750
  • Fax: 321-842-3651
Mailing address:
  • Phone: 321-842-4750
  • Fax: 321-842-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9194115
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9194115
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9194115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: