Provider Demographics
NPI:1912269861
Name:STOTT, PATRICIA M (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:STOTT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CROSSING BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4154
Mailing Address - Country:US
Mailing Address - Phone:518-831-4434
Mailing Address - Fax:518-831-4435
Practice Address - Street 1:3 CROSSING BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4154
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4435
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306057363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01305423OtherRAILROAD MEDICARE
J400075435Medicare PIN