Basic Information
| Provider Information | |||||||||
| NPI: | 1780772210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 494710 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339494710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416132400 | ||||||||
| FaxNumber: | 9416132401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1617 TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339481040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416132400 | ||||||||
| FaxNumber: | 9416132401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1981882 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1255052 | 01 | FL | UHC | OTHER | 08153 | 01 | FL | BC/BS FL | OTHER | 5872736 | 01 | FL | AETNA | OTHER | 6417334 | 01 | FL | CIGNA | OTHER |