Healthcare Provider Details

I. General information

NPI: 1831324094
Provider Name (Legal Business Name): KIMBERLY HARTZELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8061 SPYGLASS HILL RD STE 103
MELBOURNE FL
32940-8297
US

IV. Provider business mailing address

8061 SPYGLASS HILL RD STE 103
MELBOURNE FL
32940-8297
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2767
  • Fax:
Mailing address:
  • Phone: 407-898-2767
  • Fax: 205-975-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME122825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: