Healthcare Provider Details

I. General information

NPI: 1649986217
Provider Name (Legal Business Name): KIMBERLEI RENEE SAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 UNIVERSITY PKWY STE A
PENSACOLA FL
32514-4949
US

IV. Provider business mailing address

2210 TWIN LAKES DR
BAINBRIDGE GA
39819-5278
US

V. Phone/Fax

Practice location:
  • Phone: 850-324-9633
  • Fax: 850-470-6460
Mailing address:
  • Phone: 850-743-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11024057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: