Basic Information
| Provider Information | |||||||||
| NPI: | 1518145168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDRY | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 16568 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322456568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044722300 | ||||||||
| FaxNumber: | 9044722330 | ||||||||
| Practice Location | |||||||||
| Address1: | 14546 OLD SAINT AUGUSTINE RD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322585468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042451328 | ||||||||
| FaxNumber: | 9045625335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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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 | ARNP732082 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 005612900 | 05 | FL | MEDICAID |