Provider Demographics
NPI:1063906865
Name:ECCHER, KIMBERLY (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ECCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 STATE ROAD 13 STE 11-926
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8856
Mailing Address - Country:US
Mailing Address - Phone:888-730-5220
Mailing Address - Fax:
Practice Address - Street 1:1820 STATE ROAD 13 STE 11-926
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8856
Practice Address - Country:US
Practice Address - Phone:888-730-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant