Provider Demographics
NPI:1396147930
Name:TROY, PATRICK JOSEPH (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:TROY
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:STE. 365
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:313-343-4886
Mailing Address - Fax:313-343-4120
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:STE. 365
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-4886
Practice Address - Fax:313-343-4120
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292714163WC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine