Provider Demographics
NPI:1609406701
Name:JARRELL, PATRICE (RN,PMD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:JARRELL
Suffix:
Gender:F
Credentials:RN,PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:SW RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1310
Mailing Address - Country:US
Mailing Address - Phone:954-240-3959
Mailing Address - Fax:
Practice Address - Street 1:1625 N COMMERCE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3206
Practice Address - Country:US
Practice Address - Phone:954-765-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9371915163W00000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other