MEDICARE: MRS. KIMBERLY H BIBB APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN9165603	FL
2	363LF0000X	Family Nurse Practitioner	APRN9165603	FL
3	363LF0000X	Family Nurse Practitioner	ARNP 9165603	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01390059	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336542430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY H BIBB APRN

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	907-376-4075

Provider Business Practice Location Address
First Line	:	1210 VINTAGE WAY
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-0299
Country	:	US
Telephone Number	:	904-261-0922
Fax Number	:	904-390-7477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	12/15/2025

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