Provider Demographics
NPI:1336039403
Name:PATA, JEREMY DAMON (NP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAMON
Last Name:PATA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 W ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-1349
Mailing Address - Country:US
Mailing Address - Phone:520-822-4534
Mailing Address - Fax:
Practice Address - Street 1:10308 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-1349
Practice Address - Country:US
Practice Address - Phone:520-822-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ326622363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health