Provider Demographics
NPI:1598700197
Name:PIJUT, PATTI DIRKSE (CRNA)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:DIRKSE
Last Name:PIJUT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 WILLIE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-0878
Mailing Address - Country:US
Mailing Address - Phone:850-566-4834
Mailing Address - Fax:850-216-2534
Practice Address - Street 1:2030 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4599
Practice Address - Country:US
Practice Address - Phone:850-219-2000
Practice Address - Fax:850-877-2138
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2505852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307593100Medicaid
FLG1566OtherBCBSFL
GA000876884BMedicaid
FL307593100Medicaid