Provider Demographics
NPI:1396920492
Name:KIRCHGESSNER, NINA R (ARNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:R
Last Name:KIRCHGESSNER
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:R
Other - Last Name:CUTTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1790 E VENICE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3191
Mailing Address - Country:US
Mailing Address - Phone:941-488-8884
Mailing Address - Fax:941-488-5554
Practice Address - Street 1:1790 E VENICE AVE STE 204
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3191
Practice Address - Country:US
Practice Address - Phone:941-488-8884
Practice Address - Fax:941-488-5554
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1973363L00000X, 363LA2200X, 363LP0808X
FLARNP9293213363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113067Medicaid
SC254492OtherCOMPSYCH
SCAA30158552OtherMEDICARE PTAN
FL2275621OtherCIGNA
FL9531492OtherAETNA
SCNP1255Medicaid
SC212977OtherMEDCOST
600657-204OtherMAGELLAN
FLPENDINGMedicaid
SC100129030OtherAPS HEALTHCARE
FLPENDINGMedicaid