Healthcare Provider Details

I. General information

NPI: 1760698104
Provider Name (Legal Business Name): BARBARA JANE PATTERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 A1A BEACH BLVD #109 ANASTASIA PLAZA
ST AUGUSTINE BEACH FL
32080-6733
US

IV. Provider business mailing address

733 CUSTWOOD DRIVE
ST AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-234-5322
  • Fax: 904-234-5322
Mailing address:
  • Phone: 904-234-5322
  • Fax: 904-797-7684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9173894NP
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: