1760698104 NPI number — MS. BARBARA JANE PATTERSON ARNP

Table of content: MS. BARBARA JANE PATTERSON ARNP (NPI 1760698104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760698104 NPI number — MS. BARBARA JANE PATTERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
BARBARA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760698104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 CUSTWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-234-5322
Provider Business Mailing Address Fax Number:
904-797-7684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1093 A1A BEACH BLVD
Provider Second Line Business Practice Location Address:
#109 ANASTASIA PLAZA
Provider Business Practice Location Address City Name:
ST AUGUSTINE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32080-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-234-5322
Provider Business Practice Location Address Fax Number:
904-234-5322
Provider Enumeration Date:
05/15/2007

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: 363LF0000X , with the licence number:  9173894NP , 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)





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