Provider Demographics
NPI:1811900988
Name:FORSYTH, PATRICIA (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FORSYTH
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 862233
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2233
Mailing Address - Country:US
Mailing Address - Phone:954-276-5575
Mailing Address - Fax:
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-986-6363
Practice Address - Fax:954-981-3872
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1799532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3449ZMedicare ID - Type Unspecified
FLS95452Medicare UPIN