Healthcare Provider Details

I. General information

NPI: 1023557469
Provider Name (Legal Business Name): PATRICK ETIENNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E 25TH ST
HIALEAH FL
33013-3814
US

IV. Provider business mailing address

5250 SW 141ST TER
MIRAMAR FL
33027-5979
US

V. Phone/Fax

Practice location:
  • Phone: 347-526-6914
  • Fax:
Mailing address:
  • Phone: 347-526-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9231049
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number488333
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD185549
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: