Provider Demographics
NPI:1326704651
Name:FELDHAUS, BARBARA BLAIR
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:BLAIR
Last Name:FELDHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 NANCY AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4552
Mailing Address - Country:US
Mailing Address - Phone:813-739-9223
Mailing Address - Fax:
Practice Address - Street 1:690 GUZZI LN STE B
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5292
Practice Address - Country:US
Practice Address - Phone:209-536-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant