Provider Demographics
NPI:1528010055
Name:KIRBY, RICKY MCCOY (ARNP)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:MCCOY
Last Name:KIRBY
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:4291 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2061
Practice Address - Country:US
Practice Address - Phone:904-598-1888
Practice Address - Fax:904-384-4928
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3022752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57573BOtherMEDICARE LEGACEY NUMBER
FLK4319Medicare PIN
FLP44927Medicare UPIN
FLE6548YMedicare PIN