Provider Demographics
NPI:1710249016
Name:ROXY BARBER ACUPUNCTURE & AESTHETICS, LLC
Entity Type:Organization
Organization Name:ROXY BARBER ACUPUNCTURE & AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-489-7778
Mailing Address - Street 1:4001 NORTH OCEAN DRIVE
Mailing Address - Street 2:STE 301
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-489-7778
Mailing Address - Fax:
Practice Address - Street 1:4001 NORTH OCEAN DRIVE
Practice Address - Street 2:STE 301
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-489-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC00FYOtherBCBS