Provider Demographics
NPI:1497447478
Name:MCGOUGH, PATRICK (RN)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13830 WATERBURY CT APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5707
Mailing Address - Country:US
Mailing Address - Phone:478-954-2631
Mailing Address - Fax:
Practice Address - Street 1:13830 WATERBURY CT APT 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5707
Practice Address - Country:US
Practice Address - Phone:478-954-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9535788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse