Provider Demographics
NPI:1760410781
Name:WRIGHT, DIRK DAVE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:DAVE
Last Name:WRIGHT
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 1:1108 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5032
Mailing Address - Country:US
Mailing Address - Phone:813-949-2486
Mailing Address - Fax:866-615-5009
Practice Address - Street 1:1108 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5032
Practice Address - Country:US
Practice Address - Phone:813-949-2486
Practice Address - Fax:866-615-5009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3240232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3240232OtherLICENSE #
FLU4640XMedicare PIN
FLQ43720Medicare UPIN