Provider Demographics
NPI:1164028601
Name:PATEL, PRIYANKA (APRN)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 COBBLEFIELD CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7968
Mailing Address - Country:US
Mailing Address - Phone:732-744-4449
Mailing Address - Fax:
Practice Address - Street 1:12311 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2673
Practice Address - Country:US
Practice Address - Phone:904-262-7211
Practice Address - Fax:904-262-6995
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner