Healthcare Provider Details

I. General information

NPI: 1083830863
Provider Name (Legal Business Name): JOHN EDWARD PATTON II A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 MICHIGAN AVE
NAPLES FL
34103-8803
US

IV. Provider business mailing address

27221 SUN AQUA LN
BONITA SPRINGS FL
34135-4761
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-6828
  • Fax: 239-649-4915
Mailing address:
  • Phone: 239-262-6828
  • Fax: 239-649-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP488
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: