Healthcare Provider Details

I. General information

NPI: 1427409457
Provider Name (Legal Business Name): KRISTIN E DAMMANN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E NASA BLVD
MELBOURNE FL
32901-1950
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5626
  • Fax:
Mailing address:
  • Phone: 321-361-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9109618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: