Healthcare Provider Details

I. General information

NPI: 1063785178
Provider Name (Legal Business Name): KIMBERLEY KAY DRURY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 LITTLE RD
TRINITY FL
34655-1811
US

IV. Provider business mailing address

600 E. DIXIE AVENUE ATTN: EDNA P - CREDENTIALING
LEESBURG FL
34748
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-6400
  • Fax:
Mailing address:
  • Phone: 352-323-4267
  • Fax: 352-323-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9237691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: