Provider Demographics
NPI:1306399126
Name:PATTON, LAELISHA (ARNP)
Entity Type:Individual
Prefix:
First Name:LAELISHA
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 SWILCAN BRIDGE LN N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5617
Mailing Address - Country:US
Mailing Address - Phone:904-281-0944
Mailing Address - Fax:904-281-5356
Practice Address - Street 1:1075 OAKLEAF PLANTATION PKWY
Practice Address - Street 2:#108
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3624
Practice Address - Country:US
Practice Address - Phone:904-282-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily