Provider Demographics
NPI:1386933570
Name:FITZ, JUSTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:FITZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 N WICKHAM RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8096
Mailing Address - Country:US
Mailing Address - Phone:321-428-4737
Mailing Address - Fax:321-241-6457
Practice Address - Street 1:7960 N WICKHAM RD STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8096
Practice Address - Country:US
Practice Address - Phone:321-428-4737
Practice Address - Fax:321-241-6457
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105662363A00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant