Female

Kimberly A. Vonderlieth PA

Surgical Physician Assistant in Melbourne, FL(View on Map)

Full Name

Kimberly Ann Vonderlieth PA

NPI Number

1396917522

NPI Type

Individual Provider

Gender

Female

Enumeration Date

03/27/2008

Specialties

(Taxonomies)

Code

363AS0400X
363AM0700X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

PA9101648

Contact
Information

Purpose

Mailing
Location

Address

3300 S FISKE BLVD
1350 HICKORY ST

City

Rockledge
Melbourne

State

FL
FL

Postal Code

32955-4306
32901-3224

Country

US
US

Telephone Number

(321) 434-1401
(321) 434-1401

Identifiers

Identifier

LS853
104257000
LY388

Identifier State

FL
FL
FL

Identifier Issuer

FL MEDICARE
Unknown
FL MEDICARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 01/17/2024

Provider Address

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