Individual
IMTITHAL KISIRWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGACNP, FNP
Contact information
Practice address
3100 WESTON RD, WESTON, FL 33331-3602
(954) 659-5000
Mailing address
3100 WESTON RD, WESTON, FL 33331-3602
(954) 659-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11046769
FL
363L00000X
Nurse Practitioner
CNP5149
MN
Other
Enumeration date
05/03/2017
Last updated
07/14/2026
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