Provider Demographics
NPI:1609837269
Name:FLEETWOOD, PATRICIA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JEAN
Other - Last Name:GEBRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1521 WOODBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2161
Mailing Address - Country:US
Mailing Address - Phone:757-580-9086
Mailing Address - Fax:
Practice Address - Street 1:501 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6080
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024038930367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered