Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP9188450 | FL |
NPI | 1003891771 |
---|---|
Provider Name | Dr. Kimberly A Womack |
First Address | Gulf Breeze, FL 32561-4835 |
Second Address | Gulf Breeze, FL 32561-4835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
304536600 | (05) | FL |
P36732 | (02) |