Healthcare Provider Details

I. General information

NPI: 1902686264
Provider Name (Legal Business Name): VALERIE M PITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MIRACLE STRIP PKWY
MARY ESTHER FL
32569-1988
US

IV. Provider business mailing address

124 EAST MIRACLE PARKWAY
MARY ESTHER FL
32569
US

V. Phone/Fax

Practice location:
  • Phone: 844-729-2242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-299895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: