Provider Demographics
NPI:1396536728
Name:PATTERSON, TERESA (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3531
Mailing Address - Country:US
Mailing Address - Phone:904-654-1474
Mailing Address - Fax:
Practice Address - Street 1:5951 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-3531
Practice Address - Country:US
Practice Address - Phone:904-654-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL680269376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide