Provider Demographics
NPI:1427104181
Name:PESSAR, PATRICIA RENEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RENEE
Last Name:PESSAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 POPE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4679
Mailing Address - Country:US
Mailing Address - Phone:863-293-2144
Mailing Address - Fax:863-293-3732
Practice Address - Street 1:550 POPE AVE NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4679
Practice Address - Country:US
Practice Address - Phone:863-293-2144
Practice Address - Fax:863-293-3732
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104017363A00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant