Provider Demographics
NPI:1013332303
Name:BARBERAN, TINA FUJIKO (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:FUJIKO
Last Name:BARBERAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 RISING RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5790
Mailing Address - Country:US
Mailing Address - Phone:301-829-7683
Mailing Address - Fax:
Practice Address - Street 1:1302 RISING RIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5790
Practice Address - Country:US
Practice Address - Phone:301-829-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171545367500000X
MDAC002326367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013332303Medicaid
VA1013332303Medicaid