Provider Demographics
NPI:1790878510
Name:PATANE, JEFFREY DEAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DEAN
Last Name:PATANE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5287 SE SWEETBRIER TER
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7810
Mailing Address - Country:US
Mailing Address - Phone:772-631-4142
Mailing Address - Fax:
Practice Address - Street 1:5287 SE SWEETBRIER TER
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-7810
Practice Address - Country:US
Practice Address - Phone:772-631-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102979363AM0700X
NC0010-04808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09Y9OtherBCBS OF FLORIDA
FLP01065481OtherRAILROAD MEDICARE
FLP01065481OtherRAILROAD MEDICARE
FLU32417Medicare UPIN