Healthcare Provider Details

I. General information

NPI: 1518024249
Provider Name (Legal Business Name): PATRICIA SUE PAYETTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SW 5TH ST
OCALA FL
34471
US

IV. Provider business mailing address

3309 SW 34TH CIR STE 101
OCALA FL
34474-3392
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-0509
  • Fax: 352-237-9808
Mailing address:
  • Phone: 352-237-0509
  • Fax: 352-237-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3344312
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberARNP3344312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: