Provider Demographics
NPI:1790777548
Name:PATTON, JINA L (ACNP-PP)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:L
Last Name:PATTON
Suffix:
Gender:F
Credentials:ACNP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23547
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66283-0547
Mailing Address - Country:US
Mailing Address - Phone:503-351-4261
Mailing Address - Fax:
Practice Address - Street 1:600 W HILLSBORO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1610
Practice Address - Country:US
Practice Address - Phone:954-862-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75583-121363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269799Medicaid
OR269799Medicaid
OR131596Medicare ID - Type Unspecified