Provider Demographics
NPI:1902117716
Name:OSBORNE, PATTI SUE (FNP)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:SUE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 SW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4445
Mailing Address - Country:US
Mailing Address - Phone:352-732-4032
Mailing Address - Fax:352-620-0419
Practice Address - Street 1:3130 SW 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4445
Practice Address - Country:US
Practice Address - Phone:352-732-4032
Practice Address - Fax:352-620-0419
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003202A363L00000X, 363LP2300X
FL9455190363LP2300X
FLAPRN9455190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000666949OtherANTHEM
FL100765200Medicaid
IN200987400Medicaid