Provider Demographics
NPI:1649983925
Name:BULLOCK, PATRICE ANDREA (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:ANDREA
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W RING FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5303
Mailing Address - Country:US
Mailing Address - Phone:443-876-6692
Mailing Address - Fax:
Practice Address - Street 1:151 W RING FACTORY RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5303
Practice Address - Country:US
Practice Address - Phone:443-876-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136729363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care