=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215289921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA PATTERSON DNP, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2012
-----------------------------------------------------
Last Update Date | 12/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1906 SOUTHSIDE BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-724-3083
-----------------------------------------------------
Fax | 904-727-9103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7855 ARGYLE FOREST BLVD STE 101
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32244-5597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-282-6331
-----------------------------------------------------
Fax | 904-282-4117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9177700
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------