Provider Demographics
NPI:1629623269
Name:BARGER, WAYNE LYNN (CNA 362913)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LYNN
Last Name:BARGER
Suffix:
Gender:M
Credentials:CNA 362913
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8507
Mailing Address - Country:US
Mailing Address - Phone:858-850-7761
Mailing Address - Fax:
Practice Address - Street 1:7542 BREVARD ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6650
Practice Address - Country:US
Practice Address - Phone:850-736-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3629133747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider