Provider Demographics
NPI:1033745211
Name:RODDEY, BARRON NICHOLAS (APRN)
Entity Type:Individual
Prefix:
First Name:BARRON
Middle Name:NICHOLAS
Last Name:RODDEY
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 1:1181 ANCLOTE RD LOT 35
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6642
Mailing Address - Country:US
Mailing Address - Phone:727-946-1074
Mailing Address - Fax:
Practice Address - Street 1:1181 ANCLOTE RD LOT 35
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-6642
Practice Address - Country:US
Practice Address - Phone:727-946-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006384363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care