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General NPI Number Information
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NPI Number | 1821135047
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Entity Type | Individual
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Provider Name | KIMBERLY DISHAROON STITIK ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 2211 60TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-5569
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Country | US
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Telephone | 941-761-0663
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Fax | 941-761-3347
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Provider Business Mailing Address
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Address Line | 10167 CHERRY HILLS AVENUE CIR
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City | BRADENTON
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State | FL
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Zip | 34202-4046
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Country | US
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Telephone | 941-727-0810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP3399052
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License Number State | FL
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