1336489749 NPI number — PATRICIA KATHLEEN SPITZER PA

Table of content: PATRICIA KATHLEEN SPITZER PA (NPI 1336489749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336489749 NPI number — PATRICIA KATHLEEN SPITZER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPITZER
Provider First Name:
PATRICIA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLICH
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336489749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 LAUREL MANOR DR STE 224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-751-6565
Provider Business Mailing Address Fax Number:
352-205-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 LAUREL MANOR DR STE 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-751-6565
Provider Business Practice Location Address Fax Number:
352-205-7777
Provider Enumeration Date:
02/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9106818 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)