Basic Information
| Provider Information | |||||||||
| NPI: | 1699771576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITTS | ||||||||
| FirstName: | DAPHNE | ||||||||
| MiddleName: | MARIAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13160 SW 13TH ST | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333255571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546121952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14050 NW 14TH ST | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544751300 | ||||||||
| FaxNumber: | 9544243270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD0000028451 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME90371 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 269979600 | 05 | FL | MEDICAID |