KIMBERLEY NICHOLE WISSNER (NPI# 1275152852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275152852 |
| Entity Type | Individual |
| Full Name | KIMBERLEY NICHOLE WISSNER |
| Practice Address |
3250 Zemke Ave Tampa FL 33621-5023 |
| Practice Telephone | 8138279067 |
| Mailing Telephone | 8138279067 |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
3250 ZEMKE AVE |
| City | TAMPA |
| State | FL |
| Zip Code | 33621-5023 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184621856 | Michael Andre Couvillon | Nurse Practitioner | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2005-07-07 |
| 1437756343 | Molly Buchanan | Optometrist | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2020-10-04 |
| 1851917967 | Cristina Brock De Jesus | Nurse Practitioner | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2020-06-24 |
| 1588283188 | Echo Sims | Military Health Care Provider | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2020-04-13 |
| 1275171233 | Michael David Jensen | Nurse Practitioner | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2019-12-20 |
| 1023661196 | Jazzy-mae Nieto | Military Health Care Provider | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2019-07-18 |
| 1588227243 | Max E Lindgren | Physician Assistant | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2019-04-18 |
| 1366904948 | Sindy Johanna Maldonado | Physician Assistant | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2019-04-03 |
| 1164993135 | Jessica Hague | Psychologist | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2018-12-17 |
| 1396216578 | Colleen Bernal | Military Health Care Provider | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2018-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134644750 | Kwanza Lincoln | Military Health Care Provider | 3520 Zemke Ave, Tampa, FL 33621 | 2017-08-04 |
| 1922407659 | Michelle Lind | Social Worker | 8126 Hangar Loop Dr, 927the Arw - Bldg 296, Room 231, Tampa, FL 33621 | 2014-08-19 |
| 1588932768 | Katherine Holmes | Physician Assistant | 6th Medical Group, 3250 Zemke Ave, Macdill Afb, FL 33621 | 2011-12-02 |
| 1558378273 | Graeme Charles Bicknell | Social Worker | 4815 Bayshore Blvd, 6th Medical Group, Tampa, FL 33621 | 2006-08-02 |
| 1659346146 | Laura Umfer | Psychologist | 4515 Bayshore Blvd, Tampa, FL 33621 | 2006-02-20 |
| 1205808516 | Kenneth Joseph Baron | Physician Assistant | 3250 Zemke Ave #1078, 6th Medical Group, Macdill Afb, FL 33621 | 2006-02-02 |
| 1760478044 | Michael Glenn Hodges | Family Medicine | 3250 Zerkle Avenue, Macdill Afb, FL 33621 | 2005-09-22 |
| 1003801242 | Heather Ann Newman | Nurse Anesthetist, Certified Registered | 6th Medical Group/sghc, 8415 Bayshore Blvd, Macdill Afb, FL 33621 | 2005-09-14 |
| 1861486789 | Daniel N. Park | Physician Assistant | Ussocom Clinic, 3250 Zemke Ave, Macdill Afb, FL 33621 | 2005-09-07 |
| 1164675070 | 6 Medical Group | Military Hospital | 8415 Bayshore Blvd, Macdill Base, Tampa, FL 33621 | 2008-10-23 |
| Find all providers in zip 33621 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639506579 | Aaron Newby | Military Health Care Provider | 3434 Skysail Pl, Tampa, FL 33607-5828 | 2013-10-10 |
| 1043593221 | Elaine Jimenez | Military Health Care Provider | 1811 Mobility Ln, Tampa, FL 33621-1500 | 2011-09-23 |
| 1376787168 | Enoch Walter Daniels | Military Health Care Provider | 7448 Chevron Park Dr, Tampa, FL 33621-1700 | 2009-04-24 |
| 1588283188 | Echo Sims | Military Health Care Provider | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2020-04-13 |
| 1023661196 | Jazzy-mae Nieto | Military Health Care Provider | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2019-07-18 |
| 1538397898 | Nicole Gonzalez | Military Health Care Provider | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2009-06-25 |
| 1184851529 | Angela Noel Messer | Military Health Care Provider | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2009-06-12 |
| 1508091778 | Cynthia Marie Milanese | Military Health Care Provider | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2009-05-18 |
| 1184868861 | Christopher Lawson | Military Health Care Provider | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2009-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994394 | Nathaniel Clay Hollandsworth | Military Health Care Provider | 517 Harrison Dr, Hurlburt Field, FL 32544-1100 | 2019-10-23 |
| 1316592355 | Tiffany Nicole Monroe | Military Health Care Provider | 6280 Ferguson Dr, Pensacola, FL 32503-7769 | 2019-08-06 |
| 1881197069 | David Joseph Bergstrom | Military Health Care Provider | 2293 Frontera St, Navarre, FL 32566-6202 | 2018-03-14 |
| 1144723321 | Paris Johnae Milton | Military Health Care Provider | 340 Magnolia Cir # 5612, Tyndall Afb, FL 32403-5604 | 2018-03-14 |
| 1538681226 | Qynne M Shoemaker | Military Health Care Provider | 1008 E Strawbridge Ave, Melbourne, FL 32901-4909 | 2017-07-13 |
| 1891196531 | Lorex Boy Lagora | Military Health Care Provider | 1010 Nw 91st St, Miami, FL 33150-2352 | 2014-09-12 |
| 1366865321 | Stephanie Fike | Military Health Care Provider | 2804 Winners Circle Dr, Navarre, FL 32566-8820 | 2014-01-28 |
| 1821439712 | Eric John Muelhausen | Military Health Care Provider | 6151 Evergreen Pkwy, Crestview, FL 32539-7702 | 2013-07-09 |
| 1457790875 | Caige Carter Chapman | Military Health Care Provider | 1935 Jo Tam Lane, Navarre, FL 32566 | 2013-06-19 |
| 1164861704 | Jared Steven Sleeman | Military Health Care Provider | 524 Tikell Dr, Crestview, FL 32536-5427 | 2013-06-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.