Provider Demographics
NPI:1609660208
Name:KIRKWOOD, DEMETRICE DANYAL
Entity type:Individual
Prefix:
First Name:DEMETRICE
Middle Name:DANYAL
Last Name:KIRKWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36162 JOSEPH BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-8237
Mailing Address - Country:US
Mailing Address - Phone:813-619-2914
Mailing Address - Fax:
Practice Address - Street 1:36162 JOSEPH BLAKE ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-8237
Practice Address - Country:US
Practice Address - Phone:813-619-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator