Provider Demographics
NPI:1588005375
Name:PATIL, PORSCHE (MSN, APRN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PORSCHE
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:MSN, APRN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 W VILLAGE JUNCTION WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-9271
Mailing Address - Country:US
Mailing Address - Phone:352-222-9626
Mailing Address - Fax:
Practice Address - Street 1:2273 W VILLAGE JUNCTION WAY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-9271
Practice Address - Country:US
Practice Address - Phone:352-222-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228425363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health