Provider Demographics
NPI:1700254992
Name:PARKS, PATRICIA WEED (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WEED
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 THOMASWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7915
Mailing Address - Country:US
Mailing Address - Phone:850-656-4555
Mailing Address - Fax:850-656-4557
Practice Address - Street 1:1355 THOMASWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-656-4555
Practice Address - Fax:850-656-4557
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLII495XMedicare PIN