Provider Demographics
NPI:1144090192
Name:BISHOP, KIMBERLEE JOY (DNP, APRN, CRNA)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:JOY
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DNP, APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 HARVESTER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4022
Mailing Address - Country:US
Mailing Address - Phone:434-841-4404
Mailing Address - Fax:
Practice Address - Street 1:1525 W CYPRESS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:850-385-0144
Practice Address - Fax:850-385-0146
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered