Provider Demographics
NPI:1174092134
Name:PARKS, PATRICIA (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31207 HAYMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5852
Mailing Address - Country:US
Mailing Address - Phone:571-271-2743
Mailing Address - Fax:
Practice Address - Street 1:31207 HAYMAN LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-5852
Practice Address - Country:US
Practice Address - Phone:571-271-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176926363LF0000X, 363LP0808X
FL11014464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11014464OtherFLORIDA LICENSE