Provider Demographics
NPI:1679727143
Name:FLORENCE, KIMBERLY S (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC-REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:2 JAN SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-833-8247
Practice Address - Fax:508-833-6535
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA197921363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health