Provider Demographics
NPI:1194565879
Name:PATTERSON-BAUMAN, MICHELE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PATTERSON-BAUMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3199
Mailing Address - Country:US
Mailing Address - Phone:386-615-8971
Mailing Address - Fax:
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3199
Practice Address - Country:US
Practice Address - Phone:609-816-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033047363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology