Provider Demographics
NPI:1265475693
Name:BARRAGAN, ANNETTE (RN, NPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:RN, NPC
Other - Prefix:MISS
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:ESTEVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:20 GATHERING RD
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9568
Mailing Address - Country:US
Mailing Address - Phone:973-396-2522
Mailing Address - Fax:
Practice Address - Street 1:20 W RIDGEWOOD AVE # 7
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3117
Practice Address - Country:US
Practice Address - Phone:201-251-2900
Practice Address - Fax:201-652-2782
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN102606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00173885OtherRAILROAD MEDICARE
NJ7758308Medicaid
NJ019911B3LMedicare ID - Type Unspecified
NJ7758308Medicaid