Provider Demographics
NPI:1265554786
Name:MCTAGUE, PATRICIA L (MSN, CFNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:MCTAGUE
Suffix:
Gender:F
Credentials:MSN, CFNP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3227 BELLE ISLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2906
Mailing Address - Country:US
Mailing Address - Phone:619-282-6063
Mailing Address - Fax:
Practice Address - Street 1:8695 SPECTRUM CENTER BLVD
Practice Address - Street 2:ROOM 119
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1489
Practice Address - Country:US
Practice Address - Phone:858-499-5259
Practice Address - Fax:858-499-5317
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE221530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily