Provider Demographics
NPI:1386678001
Name:KIRBY, CURTIS (PA-C)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23343NWCOUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:911 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3239
Practice Address - Country:US
Practice Address - Phone:352-463-2374
Practice Address - Fax:352-463-4507
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2747363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12785OtherBC
FL290456000Medicaid
FLME0011709OtherMEDICAL LICENSE
FL101936Medicare ID - Type UnspecifiedUGS MC
FLS62647Medicare UPIN
FL290456000Medicaid
FL080104791Medicare ID - Type UnspecifiedRR MC