Provider Demographics
NPI:1417633744
Name:SPITLER, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:SPITLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 COLLINGSWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1059
Mailing Address - Country:US
Mailing Address - Phone:702-984-9500
Mailing Address - Fax:
Practice Address - Street 1:1475 COLLINGSWOOD BLVD
Practice Address - Street 2:UNIT G
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1059
Practice Address - Country:US
Practice Address - Phone:941-587-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician