Provider Demographics
NPI:1184856262
Name:POLLEY, PATTY LANAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:LANAN
Last Name:POLLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PATTY
Other - Middle Name:LANAN
Other - Last Name:POLLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7004 NORNE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7076
Mailing Address - Country:US
Mailing Address - Phone:407-361-7565
Mailing Address - Fax:352-383-6689
Practice Address - Street 1:7004 NORNE LN
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7076
Practice Address - Country:US
Practice Address - Phone:407-361-7565
Practice Address - Fax:352-383-6689
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN680621164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse