Provider Demographics
NPI:1578592085
Name:NORDELO, KIM A (PA)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:A
Last Name:NORDELO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1015 SE 17TH ST
Mailing Address - Street 2:#100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3968
Mailing Address - Country:US
Mailing Address - Phone:352-351-3422
Mailing Address - Fax:351-351-9129
Practice Address - Street 1:1015 SE 17TH ST
Practice Address - Street 2:#100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3968
Practice Address - Country:US
Practice Address - Phone:352-351-3422
Practice Address - Fax:351-351-9129
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA3498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290359800Medicaid
FLE2970ZMedicare ID - Type Unspecified
FL290359800Medicaid
FLS87974Medicare UPIN