Provider Demographics
NPI:1194834259
Name:FITZMAURICE, DAVID (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FITZMAURICE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:120 INTERNATIONAL PKWY STE 240
Practice Address - Street 2:
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5033
Practice Address - Country:US
Practice Address - Phone:407-333-4200
Practice Address - Fax:407-829-6637
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291790400Medicaid
FLP66740Medicare UPIN