Provider Demographics
NPI:1992712400
Name:FITZGERALD, PATRICIA MARY (FNC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 F ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1036
Mailing Address - Country:US
Mailing Address - Phone:707-442-5335
Mailing Address - Fax:707-442-1452
Practice Address - Street 1:714 F ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1036
Practice Address - Country:US
Practice Address - Phone:707-442-5335
Practice Address - Fax:707-442-1452
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner