Provider Demographics
NPI:1972713790
Name:PATTON, DEANNA JOYCE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:DEANNA
Middle Name:JOYCE
Last Name:PATTON
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 1:100 ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5850
Mailing Address - Country:US
Mailing Address - Phone:229-886-8676
Mailing Address - Fax:
Practice Address - Street 1:801 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1340
Practice Address - Country:US
Practice Address - Phone:229-436-6688
Practice Address - Fax:229-436-0307
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3364212363LF0000X
GA036987363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300618200Medicaid
FLY0836OtherBCBSFL
FLK3109Medicare ID - Type Unspecified
FLY0836OtherBCBSFL
FLE6409ZMedicare ID - Type Unspecified