Provider Demographics
NPI:1164297529
Name:PATTAIN, MARICELA REGINA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARICELA
Middle Name:REGINA
Last Name:PATTAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARICELA
Other - Middle Name:REGINA
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1462 STARGAZER TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9215
Mailing Address - Country:US
Mailing Address - Phone:786-942-0317
Mailing Address - Fax:
Practice Address - Street 1:2201 LUCIEN WAY
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7003
Practice Address - Country:US
Practice Address - Phone:407-461-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029694363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner