Provider Demographics
NPI:1982051785
Name:STARKS, PATRICIA M (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:STARKS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:DURSTELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,
Mailing Address - Street 1:2678 S GLENMARE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3606
Mailing Address - Country:US
Mailing Address - Phone:801-583-5854
Mailing Address - Fax:
Practice Address - Street 1:2678 S GLENMARE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3606
Practice Address - Country:US
Practice Address - Phone:801-583-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344443-4405363LF0000X, 363L00000X, 363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care