Provider Demographics
NPI:1730449117
Name:PADDOCK, PATRICIA MARIE (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E. BRANDON BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-681-2622
Mailing Address - Fax:813-681-2622
Practice Address - Street 1:205 E. BRANDON BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-681-2622
Practice Address - Fax:813-681-2622
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist