Provider Demographics
NPI:1447391271
Name:SCHREIBER, FONDA K (PA-C)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:K
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FONDA
Other - Middle Name:KAY
Other - Last Name:BARTGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1286 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2484
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-633-3043
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-633-7780
Practice Address - Fax:321-633-3043
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010136-1363A00000X
FLPA9104425363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ400ZMedicare UPIN
NY5732L1Medicare ID - Type UnspecifiedPROVIDER NUMBER