DERRICK DEJUAN PETTIS (NPI# 1265637847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265637847 |
| Entity Type | Individual |
| Full Name | DERRICK DEJUAN PETTIS |
| Practice Address |
600 8th Ave Se St Petersburg FL 33701-5030 |
| Mailing Address |
11150 4th St N Apt 4301 St Petersburg FL 33716-2909 |
| Practice Telephone | 7275021602 |
| Practice Fax Number | 7275021603 |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 146N00000X | Emergency Medical Technician, Basic | B1026491 | FL | Emergency Medical Service Providers |
| Street Address |
600 8TH AVE SE |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33701-5030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477531671 | Kevin F. Cronin | Military Health Care Provider | 600 8th Ave Se, St Petersburg, USA 33701 | 2006-01-06 |
| 1558907873 | Uscg Clinic St Petersburg | Clinic/Center | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2019-11-21 |
| 1770728107 | Gabriel P Hogg | Technician, Other | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2008-12-15 |
| 1124294111 | Annelies Swarts Byington | Military Health Care Provider | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2008-04-30 |
| 1255536777 | Karen L Gordon | Dental Hygienist | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2007-06-15 |
| 1992893887 | Us Coast Guard | Technician, Other | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2006-10-10 |
| 1740387596 | St Petersburg Uscg Phcy | Military/U.S. Coast Guard Pharmacy | 600 8th Ave Se, St Petersburg, FL 33701-5030 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514603 | Tien Thuy Hoang | Pharmacist | 875 Dr M.l.k. Jr St N, St. Petersburg, FL 33701 | 2020-10-06 |
| 1851920953 | Michelle Tedrowe | Student in an Organized Health Care Education/Training Program | Bayfront Health St Petersburg Family Care Center, 700 6th Street South, St. Petersburg, FL 33701 | 2020-04-02 |
| 1164070264 | Melissa Joy Fitzpatrick | Occupational Therapist | 239 14 Ave Ne, St Petersburg, FL 33701 | 2019-09-01 |
| 1841763091 | William Carpenter Scott | Dentist | 239 2nd Ave S # 100, St Petersburg, FL 33701 | 2019-01-09 |
| 1992289318 | Westminster Senior Services, Inc. | Registered Nurse | 830 North Shore Dr. Ne, St. Petersburg, FL 33701 | 2018-09-21 |
| 1265929780 | B&b Florida Eye Care Pllc | Optometrist | 1380 4th St N, St. Petersburg, FL 33701 | 2018-04-19 |
| 1730684895 | Loraine Marie Torres Garcia | Student in an Organized Health Care Education/Training Program | Bayfront Health St Petersburg, 700 6th Street South, St Petersburg, FL 33701 | 2018-03-29 |
| 1598267445 | Vincent Malik Dehili | Psychologist | 146 2nd Street North, Suite 305, St. Petersburg, FL 33701 | 2018-03-07 |
| 1770083073 | Megan Sanborn | Nurse Practitioner | 601 5th St S Ste 304, St Petersburg, FL 33701 | 2018-02-14 |
| 1174037089 | Julius Griffin | Licensed Practical Nurse | 1115 Highland St N, Apt B, Saint Petersburg, FL 33701 | 2017-11-30 |
| Find all providers in zip 33701 | ||||
| Taxonomy Code | 146N00000X |
| Grouping | Emergency Medical Service Providers |
| Classification | Emergency Medical Technician, Basic |
| A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |
| Notes: Sources: Tabers Medical Dictionary and Florida EMS Clearing House. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275763419 | Erick Koszyk | Emergency Medical Technician, Basic | 5031 41st St S, St Petersburg, FL 33711-4713 | 2009-07-22 |
| 1437709359 | Ashley Harris | Emergency Medical Technician, Basic | 882 30th Ave S, St Petersburg, FL 33705-3634 | 2019-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831399 | Joseph Anthony Pingatore | Emergency Medical Technician, Basic | 6030 Wilkinson Rd Apt 210, Sarasota, FL 34233-3872 | 2020-04-28 |
| 1588283071 | James Bridges | Emergency Medical Technician, Basic | 2001 Saxon Dr, New Smyrna Beach, FL 32169-3246 | 2020-04-14 |
| 1891336327 | Tony Bernard Anderson Sr. | Emergency Medical Technician, Basic | 20324 Nw 36th Ct, Miami Gardens, FL 33056-1749 | 2019-10-06 |
| 1538727359 | Robert Ortega IIi | Emergency Medical Technician, Basic | 1513 Se 20th Pl, Homestead, FL 33035-2609 | 2019-06-05 |
| 1013472042 | Christine Anne Sacramento | Emergency Medical Technician, Basic | 20803 Johnson St, Pembroke Pines, FL 33029-1916 | 2019-02-04 |
| 1922502434 | David Patlak | Emergency Medical Technician, Basic | 1881 Washington Ave Apt 2h, Miami Beach, FL 33139-7445 | 2018-03-20 |
| 1164961694 | Dowil Henry | Emergency Medical Technician, Basic | 9628 Ne 2nd Ave, Suite#b3, Miami Shores, FL 33138-2767 | 2017-02-16 |
| 1841734266 | John Mccants | Emergency Medical Technician, Basic | 1302 Detour Rd, Haines City, FL 33844-9304 | 2016-12-05 |
| 1437600418 | Isabel Brasil | Emergency Medical Technician, Basic | 8928 W 35th Ln, Hialeah, FL 33018-1887 | 2016-10-14 |
| 1508316084 | Melissa Angel | Emergency Medical Technician, Basic | 3701 Winton Drive, Jacksonville, FL 32208 | 2016-10-10 |
| Find all providers with the same taxonomy | ||||
| City | ST PETERSBURG |
| Zip Code | 33701 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.