Healthcare Provider Details

I. General information

NPI: 1952210296
Provider Name (Legal Business Name): KIMBERLY IBANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86624 CARTESIAN POINTE DR
YULEE FL
32097-5813
US

IV. Provider business mailing address

86624 CARTESIAN POINTE DR
YULEE FL
32097-5813
US

V. Phone/Fax

Practice location:
  • Phone: 407-733-4251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: