MEDICARE: DAVID A PATE CRNP

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	363L00000X	Nurse Practitioner	1-045071	AL
2	363L00000X	Nurse Practitioner	APRN11012019	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051504239	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538187158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A PATE CRNP

Provider Business Mailing Address
First Line	:	PO BOX 25007
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2007
Country	:	US
Telephone Number	:	941-365-6611
Fax Number	:	888-990-1363

Provider Business Practice Location Address
First Line	:	950 S TAMIAMI TRL STE 210
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-7818
Country	:	US
Telephone Number	:	941-365-6611
Fax Number	:	888-990-1363

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/03/2025

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