Basic Information
| Provider Information | |||||||||
| NPI: | 1689642373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METHOT | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 S LAKE CANNON DR NW | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338813057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632932265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 N ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335634303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137571290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP1274492 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00263453 | 01 | FL | RR MCR | OTHER |