Individual
KIMBERLY ANN VONDERLIETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1251 HICKORY ST, MELBOURNE, FL 32901-3221
(321) 434-3420
(321) 434-3423
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3420
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9101648
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9101648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104257000
—
FL
01
—
LS853
FL MEDICARE
FL
01
—
LY388
FL MEDICARE
FL
Enumeration date
03/27/2008
Last updated
11/17/2025
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