Provider Demographics
NPI:1811225907
Name:CITTA, AUTUMN HEATHER (ARNP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:HEATHER
Last Name:CITTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:HEATHER
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:BOX 100371
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-265-0301
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100371
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0301
Practice Address - Fax:352-265-0627
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9249118363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCR461Medicare PIN