Provider Demographics
NPI:1316044472
Name:JAY, PATRICIA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:JAY
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 1:15604 EASTBOURN DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2850
Mailing Address - Country:US
Mailing Address - Phone:813-920-3664
Mailing Address - Fax:813-920-3491
Practice Address - Street 1:7820 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3852
Practice Address - Country:US
Practice Address - Phone:813-935-6060
Practice Address - Fax:813-933-8096
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1397802363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692094200OtherMEDICAID WAIVER
FL307911200Medicaid
FL692094200OtherMEDICAID WAIVER
FLAC867Medicare PIN