Provider Demographics
NPI:1093091589
Name:GITTLEN, JOHN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GITTLEN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 E FLAMINGO RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7447
Mailing Address - Country:US
Mailing Address - Phone:702-436-0835
Mailing Address - Fax:702-435-6212
Practice Address - Street 1:3085 E. FLAMINGO RD SUITE A-B
Practice Address - Street 2:CAREMORE CARE CENTER
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-436-0835
Practice Address - Fax:702-435-6212
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN 001300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily