Provider Demographics
NPI:1578732566
Name:PATTALITAN, PENELOPE NAGBUYA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:NAGBUYA
Last Name:PATTALITAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:PENELOPE
Other - Middle Name:CASIS
Other - Last Name:PATTALITAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1309 NW 161 AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-450-1190
Mailing Address - Fax:954-862-3665
Practice Address - Street 1:12555 ORANGE DRIVE
Practice Address - Street 2:SUITE 247
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:800-966-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2628122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK226YMedicare UPIN