Provider Demographics
NPI:1306234000
Name:BORN, PATRICIA ANN
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BORN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:101 MOSSRIDGE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3516
Mailing Address - Country:US
Mailing Address - Phone:210-246-2971
Mailing Address - Fax:
Practice Address - Street 1:101 MOSSRIDGE
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3516
Practice Address - Country:US
Practice Address - Phone:210-246-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily