Basic Information
Provider Information
NPI: 1427408087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATE
FirstName: ERIN
MiddleName: L
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5717 PACIFIC CENTER BLVD STE 200
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921214250
CountryCode: US
TelephoneNumber: 8588591188
FaxNumber:  
Practice Location
Address1: 1200 S PINE ISLAND RD
Address2:  
City: PLANTATION
State: FL
PostalCode: 333244413
CountryCode: US
TelephoneNumber: 8588591188
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2016
LastUpdateDate: 05/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X9233814FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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