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NPI Code Detail

MEDICARE: KIMBERLY ANNE GREENAWALT ACNP-BC

MEDICARE: KIMBERLY ANNE GREENAWALT ACNP-BC
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
1363LC0200XCritical Care Medicine Nurse PractitionerAPRN9184456FL
2363L00000XNurse PractitionerAPRN9184456FL

Other Identifiers

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

General Provider Information

NPI Number : 1578831954
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANNE GREENAWALT ACNP-BC
Provider Business Mailing Address
First Line : PO BOX 860912
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55486-0912
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number : 904-953-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2011
Last Update Date : 02/04/2026

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