Individual
GRANTLEY ITTERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
101 E MILLER ST, ORLANDO, FL 32806-2123
(407) 246-6620
Mailing address
101 E MILLER ST, ORLANDO, FL 32806-2123
(407) 246-6620
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN933083
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11023199
FL
Other
Enumeration date
07/27/2012
Last updated
11/30/2022
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