Individual
KRISTIN E DAMMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
205 E NASA BLVD, MELBOURNE, FL 32901-1950
(321) 361-5626
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 361-5626
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9109618
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018013700
—
FL
01
—
IQ360Z
MEDICARE
FL
Enumeration date
06/30/2016
Last updated
12/05/2024
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