Healthcare Provider Details

I. General information

NPI: 1114943545
Provider Name (Legal Business Name): SHERI MARIE KITTELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100238
GAINESVILLE FL
32610-0238
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5159
  • Fax:
Mailing address:
  • Phone: 352-294-8278
  • Fax: 352-265-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME99747
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME99747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: