Provider Demographics
NPI:1750035788
Name:BARBA, ALICIA PAIGE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:PAIGE
Last Name:BARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TOMAHAWK RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2920
Mailing Address - Country:US
Mailing Address - Phone:757-344-2233
Mailing Address - Fax:
Practice Address - Street 1:12700 MCMANUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4407
Practice Address - Country:US
Practice Address - Phone:757-506-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF02220271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner