Provider Demographics
NPI:1528230950
Name:KELDERHOUSE, JUSTINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:
Last Name:KELDERHOUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 NW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7936
Mailing Address - Country:US
Mailing Address - Phone:954-971-6184
Mailing Address - Fax:
Practice Address - Street 1:5333 N DIXIE HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3414
Practice Address - Country:US
Practice Address - Phone:954-771-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3059102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics