Provider Demographics
NPI:1689677494
Name:MURTHA, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MURTHA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 S MCCALL RD
Mailing Address - Street 2:STE 21
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-9517
Mailing Address - Country:US
Mailing Address - Phone:941-474-8154
Mailing Address - Fax:941-473-3583
Practice Address - Street 1:2828 S MCCALL RD
Practice Address - Street 2:STE 21
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7791
Practice Address - Country:US
Practice Address - Phone:941-474-8154
Practice Address - Fax:941-473-3583
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292132400Medicaid
FL292132400Medicaid
FLP37328Medicare UPIN