Provider Demographics
NPI:1871362897
Name:PATRICK, CHINA (CNA)
Entity type:Individual
Prefix:
First Name:CHINA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 CYPRESS GARDENS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4115
Mailing Address - Country:US
Mailing Address - Phone:321-978-6533
Mailing Address - Fax:
Practice Address - Street 1:6039 CYPRESS GARDENS BLVD
Practice Address - Street 2:STE 103
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-4115
Practice Address - Country:US
Practice Address - Phone:321-978-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL380221374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide