MEDICARE: PATRICK J FITZPATRICK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	24310	MT
2	363LF0000X	Family Nurse Practitioner	24310	MT

General Provider Information

NPI Number	:	1043290604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J FITZPATRICK RN

Provider Business Mailing Address
First Line	:	8539 GATE PKWY W
Second Line	:	APT 124
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1019
Country	:	US
Telephone Number	:	281-755-2114
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5012
Country	:	US
Telephone Number	:	904-542-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/23/2009

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