Provider Demographics
NPI:1871909895
Name:KITTELLE-CINTAS, GRACE C (APRN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:KITTELLE-CINTAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:305-777-9190
Mailing Address - Fax:305-779-0729
Practice Address - Street 1:1193 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3337
Practice Address - Country:US
Practice Address - Phone:305-777-9190
Practice Address - Fax:305-779-9190
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9163404363LP0200X
FLARNP9163404163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015034900Medicaid