Provider Demographics
NPI:1295028306
Name:FAZEKAS, BARRON NONE (CNA)
Entity Type:Individual
Prefix:MR
First Name:BARRON
Middle Name:NONE
Last Name:FAZEKAS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SAN MARCO DR
Mailing Address - Street 2:
Mailing Address - City:ISLAMORADA
Mailing Address - State:FL
Mailing Address - Zip Code:33036-3305
Mailing Address - Country:US
Mailing Address - Phone:305-664-4604
Mailing Address - Fax:
Practice Address - Street 1:111 SAN MARCO DR
Practice Address - Street 2:
Practice Address - City:ISLAMORADA
Practice Address - State:FL
Practice Address - Zip Code:33036-3305
Practice Address - Country:US
Practice Address - Phone:305-664-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA31305376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide