Provider Demographics
NPI:1629166459
Name:PITTS, TERRY P (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:P
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:PO BOX 5719
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5719
Mailing Address - Country:US
Mailing Address - Phone:352-597-0907
Mailing Address - Fax:352-597-2243
Practice Address - Street 1:11319 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-597-0907
Practice Address - Fax:352-597-2243
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP754992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
430021997OtherRRMC
FL302033900Medicaid
FL302033900Medicaid