Provider Demographics
NPI:1457875908
Name:O'ROURKE, PATRICIA ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:O'ROURKE
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 1:1016 E. SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:770-464-0280
Mailing Address - Fax:
Practice Address - Street 1:1016 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2469
Practice Address - Country:US
Practice Address - Phone:770-464-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144360363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty