Provider Demographics
NPI:1730585175
Name:PATEL, HETAL (ARNP)
Entity type:Individual
Prefix:
First Name:HETAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 VISCOUNT ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6653
Mailing Address - Country:US
Mailing Address - Phone:352-362-0310
Mailing Address - Fax:
Practice Address - Street 1:1135 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4887
Practice Address - Country:US
Practice Address - Phone:813-444-7735
Practice Address - Fax:813-742-4933
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9307732363LA2200X, 363LG0600X
FLARNP9307732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology