Provider Demographics
NPI:1922312685
Name:DENICOLA, BARBARA ROSE (NP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ROSE
Last Name:DENICOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:877-860-2271
Practice Address - Street 1:3514 BROADWAY
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2332
Practice Address - Country:US
Practice Address - Phone:561-223-4081
Practice Address - Fax:877-860-2271
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3214632363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01422787-EFF5/27/13OtherRAILROAD MEDICARE-DV3514-RB, WPB
FL008698800Medicaid
FLGP338ZMedicare PIN
FLGP338YMedicare PIN