NPI 1265637847

Derrick Dejuan Pettis

Practitioner Basic Emergency Medical Technician St Petersburg, FL

Practice location

Address: 600 8th Ave SE, St Petersburg, FL 33701-5030
Phone: (727) 502-1602
Fax: (727) 502-1603
Mailing address: 11150 4th St N APT 4301, St Petersburg, FL 33716-2909

Registered specialties

Basic Emergency Medical Technician Primary

Emergency Medical Service Providers Taxonomy 146N00000X Licence B1026491 (FL)

Other Emergency Medical Technician, Basic providers in Florida →

Registry record

NPI: 1265637847
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Jun 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.