Provider Demographics
NPI:1710079561
Name:TRAVIS, PATRICIA L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 LITTLE PATUXENT PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3540
Mailing Address - Country:US
Mailing Address - Phone:321-422-7110
Mailing Address - Fax:407-667-4338
Practice Address - Street 1:10400 LITTLE PATUXENT PKWY STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3540
Practice Address - Country:US
Practice Address - Phone:321-422-7110
Practice Address - Fax:407-667-4338
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000537367500000X
DEL60A00284367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered