Provider Demographics
NPI:1437402997
Name:PATEL, AMI MAHENDRA (RN, FNP, ARNP)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:MAHENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:RN, FNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 GINGER PINE WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3217
Mailing Address - Country:US
Mailing Address - Phone:813-767-4543
Mailing Address - Fax:
Practice Address - Street 1:15953 N FLORIDA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-8102
Practice Address - Country:US
Practice Address - Phone:813-960-4894
Practice Address - Fax:813-968-4997
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9286516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily