Provider Demographics
NPI:1609816347
Name:THOMPSON, PATRICK (PA-C)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
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 3266
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3266
Mailing Address - Country:US
Mailing Address - Phone:904-518-1299
Mailing Address - Fax:
Practice Address - Street 1:120 HEALTH PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5798
Practice Address - Country:US
Practice Address - Phone:904-819-1010
Practice Address - Fax:904-819-1040
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102388363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174540001OtherDMERC CIGNA GOUT SVCS
FLS40258Medicare UPIN
FLU6444ZMedicare ID - Type Unspecified