Healthcare Provider Details

I. General information

NPI: 1871863589
Provider Name (Legal Business Name): KIMBERLY ANN CLERMONT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN SCOTT

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 N NOVA RD STE 101
ORMOND BEACH FL
32174-5124
US

IV. Provider business mailing address

266 N NOVA RD STE 101
ORMOND BEACH FL
32174-5124
US

V. Phone/Fax

Practice location:
  • Phone: 239-220-2843
  • Fax: 239-294-7430
Mailing address:
  • Phone: 239-220-2843
  • Fax: 239-294-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9265591
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-125738
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: