Provider Demographics
NPI:1982837233
Name:BLANC, PATRICIA V (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:V
Last Name:BLANC
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-1913
Mailing Address - Country:US
Mailing Address - Phone:203-696-3260
Mailing Address - Fax:203-375-2318
Practice Address - Street 1:727 HONEYSPOT RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7172
Practice Address - Country:US
Practice Address - Phone:203-375-7242
Practice Address - Fax:203-375-2318
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4186OtherCT LICENSE
CTD400236753Medicare Oscar/Certification