Provider Demographics
NPI:1457313322
Name:BARRETT, WESLEY JON (CRNA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JON
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 SEASON DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-6440
Mailing Address - Country:US
Mailing Address - Phone:407-622-9515
Mailing Address - Fax:
Practice Address - Street 1:7050 SEASON DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6440
Practice Address - Country:US
Practice Address - Phone:407-622-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9196687367500000X
MSR841098367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001529900Medicaid
MS03786346Medicaid
S89262Medicare UPIN
MS03786346Medicaid
MS512I430119Medicare PIN