Provider Demographics
NPI:1235102260
Name:BARTLETT, NEYSA L (DO)
Entity Type:Individual
Prefix:DR
First Name:NEYSA
Middle Name:L
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718-3722 AVALON PARK EAST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4805
Mailing Address - Country:US
Mailing Address - Phone:407-518-1074
Mailing Address - Fax:407-518-9056
Practice Address - Street 1:3718-3722 AVALON PARK EAST BOULEVARD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4805
Practice Address - Country:US
Practice Address - Phone:407-518-1074
Practice Address - Fax:407-518-9056
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4390871Medicaid
MI5791690OtherAETNA
MIP95391OtherBLUE CHOICE & BCN
MI5130061OtherBCBS
MI4390871Medicaid
MIF37116Medicare UPIN