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NPI Code Detail

MEDICARE: MS. PATRICIA L MCTAGUE MSN, CFNP

MEDICARE: MS. PATRICIA L MCTAGUE MSN, CFNP
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
1363LF0000XFamily Nurse Practitioner221530DE

General Provider Information

NPI Number : 1265554786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA L MCTAGUE MSN, CFNP
Provider Business Mailing Address
First Line : 3227 BELLE ISLE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-2906
Country : US
Telephone Number : 619-282-6063
Fax Number :
Provider Business Practice Location Address
First Line : 8695 SPECTRUM CENTER BLVD
Second Line : ROOM 119
City : SAN DIEGO
State : CA
Zip : 92123-1489
Country : US
Telephone Number : 858-499-5259
Fax Number : 858-499-5317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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