Provider Demographics
NPI:1356787352
Name:PATRICK, CATHERINE LYNNE (APRN)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LYNNE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:LYNNE
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:5130 SUNFOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6327
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:813-514-8891
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28153894A363LA2200X
FLAPRN9379029363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1021200000Medicaid
FLKU719OtherMEDICARE PIN
IN715320019Medicare PIN
FLARNP9379029OtherPROFESSIONAL LICENSE