MEDICARE: MS. KIMBERLY D JASCH ARNP

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	ARNP2732962	FL
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP2732962	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1467775056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY D JASCH ARNP

Provider Business Mailing Address
First Line	:	700 8TH AVE W
Second Line	:	STE 101
City	:	PALMETTO
State	:	FL
Zip	:	34221-4737
Country	:	US
Telephone Number	:	941-776-4008
Fax Number	:	941-845-4963

Provider Business Practice Location Address
First Line	:	5460 63RD ST E
Second Line	:	STE 200 B
City	:	BRADENTON
State	:	FL
Zip	:	34203-7808
Country	:	US
Telephone Number	:	941-316-8200
Fax Number	:	941-316-8199

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

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	03/24/2017

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