Provider Demographics
NPI:1629058649
Name:BARBARO, NICOLE L (PA C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:BARBARO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 E. OAK STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257
Mailing Address - Country:US
Mailing Address - Phone:623-910-3855
Mailing Address - Fax:
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2925207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GRP
AZ453051001OtherGROUP HEALTH GRP
AZ837007Medicaid
AZ860373636OtherHUMANA GROUP
AZAW1436OtherHEALTHNET GRP
AZ453051001OtherGROUP HEALTH GRP
AZ860373636OtherHUMANA GROUP