Provider Demographics
NPI:1346241395
Name:PAGAN, PATRICK (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PAGAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 MYRSHINE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-7803
Mailing Address - Country:US
Mailing Address - Phone:251-660-8718
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9195777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305071800Medicaid
FLP72476Medicare UPIN
FLE8427ZMedicare ID - Type Unspecified