Healthcare Provider Details

I. General information

NPI: 1063363588
Provider Name (Legal Business Name): NITA MCCULLOUGH MACKEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 MASSACHUSETTS AVE
NEW PORT RICHEY FL
34653-3112
US

IV. Provider business mailing address

2126 W NASSAU ST
TAMPA FL
33607-5334
US

V. Phone/Fax

Practice location:
  • Phone: 813-999-1519
  • Fax:
Mailing address:
  • Phone: 813-217-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: