Provider Demographics
NPI:1174863351
Name:VIOLETTE, BARBARA A (APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:TACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3191 HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6755
Mailing Address - Country:US
Mailing Address - Phone:941-883-4518
Mailing Address - Fax:
Practice Address - Street 1:6360 TECHSTER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4805
Practice Address - Country:US
Practice Address - Phone:239-223-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30598363LF0000X
SC18213363LF0000X
NC263814363LF0000X
FLARNP9453346363LF0000X
FLAPRN9453346363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023004600Medicaid
SCSC07511879Medicare PIN