Provider Demographics
NPI:1356568729
Name:BLEND, KIMBERLY (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BLEND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MANATEE AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1557
Mailing Address - Country:US
Mailing Address - Phone:941-722-5600
Mailing Address - Fax:941-722-5644
Practice Address - Street 1:1911 MANATEE AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1557
Practice Address - Country:US
Practice Address - Phone:941-722-5600
Practice Address - Fax:941-722-5644
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9164246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP71911Medicare UPIN