Provider Demographics
NPI:1912054578
Name:KIRETA, DAVID A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:KIRETA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4340 NEWBERRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2557
Mailing Address - Country:US
Mailing Address - Phone:352-372-9414
Mailing Address - Fax:352-271-5393
Practice Address - Street 1:4340 NEWBERRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2557
Practice Address - Country:US
Practice Address - Phone:352-372-9414
Practice Address - Fax:352-271-5393
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00006471OtherPRESCRIBING NUMBER
FLPA9103657OtherLICENSE NUMBER
FL00006471OtherPRESCRIBING NUMBER
FLPA9103657OtherLICENSE NUMBER