Derrick Dejuan Pettis

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

License

B1026491 Issued in FL

Practice address

600 8TH Ave SE
St Petersburg, FL 33701-5030

Phone

(727) 502-1602

Fax

(727) 502-1603

NPI assigned

Jun 15, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265637847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11150 4TH ST N APT 4301",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337162909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 8TH AVE SE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337015030",
            "telephone_number": "727-502-1602",
            "fax_number": "727-502-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "DERRICK",
        "middle_name": "DEJUAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "FL",
            "license": "B1026491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent R Petronelli, APRN
• Aleksandra Petrovic, M.D.
• Alexander Petrovich, PHARM.D.
• Harold Jay Petry II, LMHC
• Kiesha E Pettine
• Quanesha Pettis
• Presley Ann Pettit
• Trishae E Petty
• Dennis Joseph Pevarski, M.D.
• Katelyn Peworchik, ARNP

• Basic Emergency Medical Technician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Basic Emergency Medical Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.