Provider Demographics
NPI:1669839767
Name:VARGAS, BARBARA N (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:N
Last Name:VARGAS
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:12500 N DALE MABRY HWY STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2809
Practice Address - Country:US
Practice Address - Phone:813-960-7533
Practice Address - Fax:813-355-5039
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016778700Medicaid
P01641433OtherRR MEDICARE
FLIL870ZMedicare PIN