Provider Demographics
NPI:1972855369
Name:MOFFATT, BARBETTA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:BARBETTA
Middle Name:ANN
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2390
Mailing Address - Fax:717-359-4178
Practice Address - Street 1:300 W KING ST
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1446
Practice Address - Country:US
Practice Address - Phone:717-339-2390
Practice Address - Fax:717-359-4178
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1613333OtherGATEWAY MEDICARE ASSURED
PA2753511OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PAP01461407Medicare PIN
PA1613333OtherGATEWAY MEDICARE ASSURED