Provider Demographics
NPI:1871533430
Name:PATTERSON, MARY ELOISE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELOISE
Last Name:PATTERSON
Suffix:
Gender:F
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 1:3980 64TH ST N
Mailing Address - Street 2:APT. 27
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4823
Mailing Address - Country:US
Mailing Address - Phone:727-344-2045
Mailing Address - Fax:
Practice Address - Street 1:3980 64TH ST N
Practice Address - Street 2:APT. 27
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4823
Practice Address - Country:US
Practice Address - Phone:727-344-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant