Provider Demographics
NPI:1669431359
Name:LANE, PATRICIA IRENE (ARNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:IRENE
Last Name:LANE
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP NEONATOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5100
Practice Address - Fax:904-244-4301
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-10-24
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2006142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101381AMedicaid
FL3068081-00Medicaid
GA003101381AMedicaid