Provider Demographics
NPI:1780772210
Name:PATTERSON, JENNIFER LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494710
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4710
Mailing Address - Country:US
Mailing Address - Phone:941-613-2400
Mailing Address - Fax:941-613-2401
Practice Address - Street 1:1617 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1040
Practice Address - Country:US
Practice Address - Phone:941-613-2400
Practice Address - Fax:941-613-2401
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1981882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255052OtherUHC
FL08153OtherBC/BS FL
FL5872736OtherAETNA
FL6417334OtherCIGNA
FLP25719Medicare UPIN
FL5872736OtherAETNA