MEDICARE: LAELISHA PATTON ARNP

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	363LF0000X	Family Nurse Practitioner	9295237	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306399126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAELISHA PATTON ARNP

Provider Business Mailing Address
First Line	:	4466 SWILCAN BRIDGE LN N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5617
Country	:	US
Telephone Number	:	904-281-0944
Fax Number	:	904-281-5356

Provider Business Practice Location Address
First Line	:	1075 OAKLEAF PLANTATION PKWY
Second Line	:	#108
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3624
Country	:	US
Telephone Number	:	904-282-4565
Fax Number	:

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

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	02/02/2018

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