Healthcare Provider Details

I. General information

NPI: 1316694466
Provider Name (Legal Business Name): KIMBERLY VINACCO APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 N DAVIS HWY
PENSACOLA FL
32514-6039
US

IV. Provider business mailing address

4 SETHSTONE DR
GREENBRIER AR
72058-9290
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-3212
  • Fax:
Mailing address:
  • Phone: 501-730-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number124074
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: