Provider Demographics
NPI:1346909421
Name:BARRETO, EDMUNDO (APRN)
Entity Type:Individual
Prefix:MR
First Name:EDMUNDO
Middle Name:
Last Name:BARRETO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-7954
Mailing Address - Country:US
Mailing Address - Phone:239-310-5269
Mailing Address - Fax:
Practice Address - Street 1:615 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-7954
Practice Address - Country:US
Practice Address - Phone:239-310-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily