Provider Demographics
NPI:1548872567
Name:PATTON, MATTHEW (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:SANT ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-420-5420
Mailing Address - Fax:850-244-8011
Practice Address - Street 1:5551 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-420-5420
Practice Address - Fax:850-244-8011
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8656207R00000X
FL11008656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108530000Medicaid