Provider Demographics
NPI:1629566989
Name:PATEL, JAGRUTIBEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JAGRUTIBEN
Middle Name:
Last Name:PATEL
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 1:205 REES ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3756
Mailing Address - Country:US
Mailing Address - Phone:229-928-4755
Mailing Address - Fax:229-928-4750
Practice Address - Street 1:205 REES ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3756
Practice Address - Country:US
Practice Address - Phone:229-928-4755
Practice Address - Fax:229-928-4750
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily