Provider Demographics
NPI:1730519687
Name:VANESKO, KIMBERLY ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:VANESKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SPERANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2114 HIGHWAY 41 STE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6204
Mailing Address - Country:US
Mailing Address - Phone:843-388-9000
Mailing Address - Fax:
Practice Address - Street 1:2114 HIGHWAY 41 STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-6204
Practice Address - Country:US
Practice Address - Phone:843-388-9000
Practice Address - Fax:843-388-6937
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00472000363LF0000X
SC27974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily