Provider Demographics
NPI:1619868783
Name:BRUMMETT, KENZIE NICOLE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:NICOLE
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32643 JESSE JONES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32643 JESSE JONES AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-7302
Practice Address - Country:US
Practice Address - Phone:813-957-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily