Provider Demographics
NPI:1871635391
Name:VLASIN, PATRICIA ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:VLASIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9921 CARMEL MOUNTAIN RD
Mailing Address - Street 2:#430
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2813
Mailing Address - Country:US
Mailing Address - Phone:619-602-6351
Mailing Address - Fax:858-901-4873
Practice Address - Street 1:9921 CARMEL MOUNTAIN RD
Practice Address - Street 2:#430
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2813
Practice Address - Country:US
Practice Address - Phone:619-602-6351
Practice Address - Fax:858-901-4873
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 9662363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9662Medicare ID - Type UnspecifiedLICENSE #
CAS54331Medicare UPIN