Provider Demographics
NPI:1447980875
Name:STEWART, KIMBERLY M (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 SHERMAN OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-2391
Mailing Address - Country:US
Mailing Address - Phone:941-564-6313
Mailing Address - Fax:
Practice Address - Street 1:11241 MIROMAR SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6229
Practice Address - Country:US
Practice Address - Phone:239-992-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily