Healthcare Provider Details

I. General information

NPI: 1790088540
Provider Name (Legal Business Name): EMILY ELIZABETH PATTERSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ELIZABETH WHEELER

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 GATE PARKWAY WEST SUITE 301 EAST COAST CARDIOLOGY
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

8075 GATE PARKWAY WEST SUITE 301 EAST COAST CARDIOLOGY
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax: 904-296-7760
Mailing address:
  • Phone: 904-296-7775
  • Fax: 904-296-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: