Provider Demographics
NPI:1548673247
Name:MCGUIRE, KITTY (PA)
Entity type:Individual
Prefix:
First Name:KITTY
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:
Other - Last Name:STACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:8383 S TAMIAMI TRL UNIT 115
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2901
Practice Address - Country:US
Practice Address - Phone:941-244-9430
Practice Address - Fax:941-244-9430
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant