1477002558 NPI number — AMY REBECCA PATTEN ARNP

Table of content: AMY REBECCA PATTEN ARNP (NPI 1477002558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477002558 NPI number — AMY REBECCA PATTEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTEN
Provider First Name:
AMY
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOW
Provider Other First Name:
AMY
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477002558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19246 WOOD SAGE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-704-7479
Provider Business Mailing Address Fax Number:
941-792-4048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GULFSIDE HOSPICE
Provider Second Line Business Practice Location Address:
6117 TROUBLE CREEK ROAD
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-995-4621
Provider Business Practice Location Address Fax Number:
941-792-4048
Provider Enumeration Date:
09/29/2016

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: 363L00000X , with the licence number:  ARNP9274058 , 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)

  • Identifier: 111408500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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