Provider Demographics
NPI:1346735586
Name:PATRICK, KATHRYN GEORGE (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GEORGE
Last Name:PATRICK
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 1:3711 BONNER RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4232
Mailing Address - Country:US
Mailing Address - Phone:601-750-4423
Mailing Address - Fax:
Practice Address - Street 1:1717 N E STREET
Practice Address - Street 2:STE 227
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-469-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9488983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9488983OtherFLORIDA BOARD OF NURSING