Healthcare Provider Details

I. General information

NPI: 1942474721
Provider Name (Legal Business Name): ELTANYA A. PATTERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELTANYA ANGELITA PATTERSON MD

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 W 23RD ST
PANAMA CITY FL
32405-4507
US

IV. Provider business mailing address

18121 NW 9TH AVE
MIAMI FL
33169-4215
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 305-308-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME115754
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME115754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: