Provider Demographics
NPI:1245453471
Name:BARNETT, MARY ANN (ARNP BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BARNETT
Suffix:
Gender:F
Credentials:ARNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 DAIRY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-5210
Mailing Address - Country:US
Mailing Address - Phone:321-327-5952
Mailing Address - Fax:321-327-5954
Practice Address - Street 1:2340 DAIRY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-5210
Practice Address - Country:US
Practice Address - Phone:321-327-5952
Practice Address - Fax:321-327-5954
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1263112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88293Medicare UPIN
U0588Medicare ID - Type Unspecified