Provider Demographics
NPI:1710139506
Name:TATE, PATRICIA MARY (MSN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA MARY
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 COLLEGE DR
Mailing Address - Street 2:SUITE100
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8530
Mailing Address - Country:US
Mailing Address - Phone:904-298-1994
Mailing Address - Fax:
Practice Address - Street 1:430 COLLEGE DR
Practice Address - Street 2:SUITE100
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8530
Practice Address - Country:US
Practice Address - Phone:904-298-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9265003363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics