Provider Demographics
NPI:1154870384
Name:KOERNER, PATRICIA PAULINE (ARNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:PAULINE
Last Name:KOERNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:PAULINE
Other - Last Name:DOLLIESLAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:395 TRAFALGA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5942
Mailing Address - Country:US
Mailing Address - Phone:386-864-0860
Mailing Address - Fax:
Practice Address - Street 1:245 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-426-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9187304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily