Provider Demographics
NPI:1437398385
Name:BARATTA, GEORGINA ANN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:ANN
Last Name:BARATTA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 THERESA LN
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3604
Mailing Address - Country:US
Mailing Address - Phone:716-523-6776
Mailing Address - Fax:
Practice Address - Street 1:4640 THERESA LN
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3604
Practice Address - Country:US
Practice Address - Phone:716-523-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-305089363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ40079014OtherMEDICARE
NY03179980Medicaid