Provider Demographics
NPI:1649889122
Name:BLOSSER, PATRICIA ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:GUADARRAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13845 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-9388
Mailing Address - Country:US
Mailing Address - Phone:607-708-3627
Mailing Address - Fax:
Practice Address - Street 1:HWY 191 ST RT 264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily