Provider Demographics
NPI:1902063886
Name:BERNAL, PATRICIA ELISE (NP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELISE
Last Name:BERNAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 E CULLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6352
Mailing Address - Country:US
Mailing Address - Phone:480-926-2888
Mailing Address - Fax:
Practice Address - Street 1:3047 E CULLUMBER ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-6352
Practice Address - Country:US
Practice Address - Phone:480-926-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily