Basic Information
| Provider Information | |||||||||
| NPI: | 1780607309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDER HEUVEL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | ARNP-BC, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13328 2ND ST E | ||||||||
| Address2: | |||||||||
| City: | MADEIRA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337082410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273971544 | ||||||||
| FaxNumber: | 7273971544 | ||||||||
| Practice Location | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
| FaxNumber: | 7275447389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 09/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | ARNP2069762 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | CK492Z | 01 | FL | MEDICARE # | OTHER |