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PEDIATRIC HEALTH & WELLNESS OF BREVARD, PA - Florida Company Profile

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Company Details

Entity Name: PEDIATRIC HEALTH & WELLNESS OF BREVARD, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 13 Jan 2025 (7 months ago)
Document Number: P25000002549
Address: 4355 LAKEMONT RD, MELBOURNE, FL, 32934, US
Mail Address: 4355 LAKEMONT RD, MELBOURNE, FL, 32934, US
ZIP code: 32934
City: Melbourne
County: Brevard
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
MARTIN KIMBERLY Director 4355 LAKEMONT RD, MELBOURNE, FL, 32934
MARTIN KIMBERLY President 4355 LAKEMONT RD, MELBOURNE, FL, 32934
MARTIN KIMBERLY Secretary 4355 LAKEMONT RD, MELBOURNE, FL, 32934
MARTIN PAUL K Director 4355 LAKEMONT RD, MELBOURNE, FL, 32934
MARTIN PAUL K Treasurer 4355 LAKEMONT RD, MELBOURNE, FL, 32934

National Provider Identifier

NPI Number:
1629880711
Certification Date:
2025-01-24

Authorized Person:

Name:
KIMBERLY M MARTIN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Documents

Name Date
Domestic Profit 2025-01-13

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Date of last update: 03 Aug 2025

Sources: Florida Department of State