Provider Demographics
NPI:1780607309
Name:VANDER HEUVEL, KIMBERLY KAY (ARNP-BC, MS)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:KAY
Last Name:VANDER HEUVEL
Suffix:
Gender:
Credentials:ARNP-BC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13328 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2410
Mailing Address - Country:US
Mailing Address - Phone:727-397-1544
Mailing Address - Fax:727-397-1544
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-9089
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2069762363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK492ZOtherMEDICARE #