Provider Demographics
NPI:1306396254
Name:PITTS, BILLY JOE JR (NP-C)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:PITTS
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7564
Mailing Address - Country:US
Mailing Address - Phone:229-237-5294
Mailing Address - Fax:
Practice Address - Street 1:472 HAND AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7564
Practice Address - Country:US
Practice Address - Phone:229-237-5294
Practice Address - Fax:229-276-2181
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily