Provider Demographics
NPI:1619983434
Name:PATINO, ERICA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:PATINO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:6333 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5800
Practice Address - Country:US
Practice Address - Phone:716-630-1484
Practice Address - Fax:716-630-1413
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303147-2363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00100487OtherRR MEDICARE
NY9512329OtherIHA
NY000560680002OtherHEALTH NOW
NY02344392Medicaid
NY161000580OtherNOVA
NYP00100487OtherRR MEDICARE
NY02344392Medicaid