Provider Demographics
NPI:1275541161
Name:FERRER, PATRICIA (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FERRER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W SAINT MARYS RD
Mailing Address - Street 2:STE A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3231
Mailing Address - Country:US
Mailing Address - Phone:520-647-1656
Mailing Address - Fax:520-254-6851
Practice Address - Street 1:140 W SPEEDWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7686
Practice Address - Country:US
Practice Address - Phone:520-628-7871
Practice Address - Fax:520-205-8460
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004171207N00000X
AZ4618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8408411Medicaid
AB27836Medicare ID - Type Unspecified
WA8408411Medicaid