Provider Demographics
NPI:1407389299
Name:MCKITRICK, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCKITRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 TROUBLE CREEK RD
Mailing Address - Street 2:STE 104
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4922
Mailing Address - Country:US
Mailing Address - Phone:727-286-3176
Mailing Address - Fax:727-286-3177
Practice Address - Street 1:5006 TROUBLE CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4922
Practice Address - Country:US
Practice Address - Phone:727-286-3176
Practice Address - Fax:727-286-3177
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22924369163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse