Provider Demographics
NPI:1760569735
Name:BARKER, NORMA JEAN
Entity Type:Individual
Prefix:MS
First Name:NORMA JEAN
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NORMA JEAN
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5251 SE 113TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3933
Mailing Address - Country:US
Mailing Address - Phone:352-502-4159
Mailing Address - Fax:
Practice Address - Street 1:5251 SE 113TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3933
Practice Address - Country:US
Practice Address - Phone:352-307-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA15155OtherMASSAGE LICENSE NUMBER
FLC-6384OtherBC/BS PROVIDER NUMBER