Healthcare Provider Details

I. General information

NPI: 1689677494
Provider Name (Legal Business Name): PATRICIA MURTHA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S MCCALL RD STE 21
ENGLEWOOD FL
34224-7791
US

IV. Provider business mailing address

2828 S MCCALL RD STE 21
ENGLEWOOD FL
34224-9517
US

V. Phone/Fax

Practice location:
  • Phone: 941-474-8154
  • Fax: 941-473-3583
Mailing address:
  • Phone: 941-474-8154
  • Fax: 941-473-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: