Provider Demographics
NPI:1295776326
Name:PATTERSON, WANITA SUE (DNP)
Entity type:Individual
Prefix:DR
First Name:WANITA
Middle Name:SUE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:WANITA
Other - Middle Name:S
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:2510 AZALEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-394-2366
Mailing Address - Fax:407-442-0668
Practice Address - Street 1:871 OUTER ROAD UNIT D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814
Practice Address - Country:US
Practice Address - Phone:407-394-2366
Practice Address - Fax:407-442-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1292052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1470YMedicare UPIN