Provider Demographics
NPI:1033404330
Name:TATE, PATRICIA L (CPNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:TATE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LORTON
Other - Last Name:PASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19212 RED BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1113
Mailing Address - Country:US
Mailing Address - Phone:949-589-5760
Mailing Address - Fax:949-589-8238
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-997-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290528363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics