Healthcare Provider Details

I. General information

NPI: 1053305813
Provider Name (Legal Business Name): PATRICIA K PRYDE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-1054
  • Fax: 727-322-2725
Mailing address:
  • Phone: 727-322-1054
  • Fax: 727-322-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberARNP2656792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: