Provider Demographics
NPI:1386665990
Name:PATTON, PAMELA R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:R
Last Name:PATTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:R
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA MSP
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0606
Mailing Address - Fax:352-265-0678
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0606
Practice Address - Fax:352-265-0678
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1781363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290327000Medicaid
S48990Medicare UPIN
FLE0156Medicare ID - Type Unspecified