Provider Demographics
NPI:1073970943
Name:CARTER MAHAMID, KIMBERLY CAMILLE (KIMBERLY CARTER PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CAMILLE
Last Name:CARTER MAHAMID
Suffix:
Gender:F
Credentials:KIMBERLY CARTER PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KIMBERLY CARTER PA-C
Mailing Address - Street 1:265 E ROLLINS ST STE 5000
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5525
Mailing Address - Country:US
Mailing Address - Phone:407-821-3540
Mailing Address - Fax:
Practice Address - Street 1:410 CELEBRATION PL STE 401A
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109235363A00000X
FLPA-9109235363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical