Provider Demographics
NPI:1083944797
Name:WROBLEWSKI, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:WROBLEWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3389
Mailing Address - Country:US
Mailing Address - Phone:954-340-5311
Mailing Address - Fax:
Practice Address - Street 1:6240 CORAL RIDGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3389
Practice Address - Country:US
Practice Address - Phone:954-340-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical