Healthcare Provider Details

I. General information

NPI: 1649485517
Provider Name (Legal Business Name): PATRICK MICHAEL DUFFY MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 COSMOS ST
MORENO VALLEY CA
92551-7308
US

IV. Provider business mailing address

16110 COSMOS ST
MORENO VALLEY CA
92551-7308
US

V. Phone/Fax

Practice location:
  • Phone: 951-601-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95065916
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9355672
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10877
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT7395
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008115
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9355672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: