Provider Demographics
NPI:1275544231
Name:PITTS, WILLARD HOUSTON (ARNP)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:HOUSTON
Last Name:PITTS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 CROWN POINT WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3700
Mailing Address - Country:US
Mailing Address - Phone:407-656-4015
Mailing Address - Fax:407-656-4879
Practice Address - Street 1:1780 CROWN POINT WOODS CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3700
Practice Address - Country:US
Practice Address - Phone:407-656-4015
Practice Address - Fax:407-656-4879
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP479762363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS50319Medicare UPIN
FLY4155YMedicare ID - Type UnspecifiedMEDICARE
FLK2689Medicare ID - Type UnspecifiedGROUP