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