MEDICARE: MS. MARY ELOISE PATTERSON PA-C

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	363A00000X	Physician Assistant	PA 9103387	FL

General Provider Information

NPI Number	:	1871533430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELOISE PATTERSON PA-C

Provider Business Mailing Address
First Line	:	3980 64TH ST N
Second Line	:	APT. 27
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4823
Country	:	US
Telephone Number	:	727-344-2045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 64TH ST N
Second Line	:	APT. 27
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4823
Country	:	US
Telephone Number	:	727-344-2045
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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