Healthcare Provider Details

I. General information

NPI: 1124338710
Provider Name (Legal Business Name): MRS. STACIE ANN KITTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACIE ANN LINDEMAN ARNP

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10381 AIR PLANT CIR
MIMS FL
32754-6203
US

IV. Provider business mailing address

10381 AIR PLANT CIR
MIMS FL
32754-6203
US

V. Phone/Fax

Practice location:
  • Phone: 407-443-4309
  • Fax: 407-349-5295
Mailing address:
  • Phone: 407-443-4309
  • Fax: 407-349-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9191961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: