Provider Demographics
NPI:1689036113
Name:PATTERSON, COY J SR
Entity Type:Individual
Prefix:MR
First Name:COY
Middle Name:J
Last Name:PATTERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32428 QUIET HARBOR AVE UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-8726
Mailing Address - Country:US
Mailing Address - Phone:352-409-2941
Mailing Address - Fax:352-435-0579
Practice Address - Street 1:32428 QUIET HARBOR AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8726
Practice Address - Country:US
Practice Address - Phone:352-409-2941
Practice Address - Fax:352-435-0579
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant