Provider Demographics
NPI:1124338710
Name:KITTMAN, STACIE ANN
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:ANN
Last Name:KITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:LINDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:10381 AIR PLANT CIR
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-6203
Mailing Address - Country:US
Mailing Address - Phone:407-443-4309
Mailing Address - Fax:407-349-5295
Practice Address - Street 1:10381 AIR PLANT CIR
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-6203
Practice Address - Country:US
Practice Address - Phone:407-443-4309
Practice Address - Fax:407-349-5295
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9191961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily