Provider Demographics
NPI:1740381888
Name:PATEL, SONAL (ARNP)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 PARK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2918
Mailing Address - Country:US
Mailing Address - Phone:904-633-2021
Mailing Address - Fax:904-633-9793
Practice Address - Street 1:1824 KING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4735
Practice Address - Country:US
Practice Address - Phone:904-388-1820
Practice Address - Fax:904-388-1827
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9197829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306346100Medicaid
FLQ23660Medicare UPIN
FLU3336ZMedicare ID - Type UnspecifiedMEDICARE