Provider Demographics
NPI:1861800963
Name:SOLOMON, PATRICIA (PAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:954-748-6665
Mailing Address - Fax:954-746-0310
Practice Address - Street 1:7200 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2148
Practice Address - Country:US
Practice Address - Phone:954-748-6665
Practice Address - Fax:954-746-0310
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical