Healthcare Provider Details

I. General information

NPI: 1699771576
Provider Name (Legal Business Name): DAPHNE MARIAN PITTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

IV. Provider business mailing address

13160 SW 13TH ST
DAVIE FL
33325-5571
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-1300
  • Fax: 954-424-3270
Mailing address:
  • Phone: 954-612-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD0000028451
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61344190
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME90371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: