Provider Demographics
NPI:1245770023
Name:BARRETT, JOHN THOMAS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:BARRETT
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 KNOWLES DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1551
Mailing Address - Country:US
Mailing Address - Phone:408-866-6651
Mailing Address - Fax:
Practice Address - Street 1:555 KNOWLES DR STE 201
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1551
Practice Address - Country:US
Practice Address - Phone:408-866-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017131363LP2300X
CA95010979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care