Provider Demographics
NPI:1669429650
Name:BARRETT, JOAN (CNS)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3113
Mailing Address - Country:US
Mailing Address - Phone:732-269-5098
Mailing Address - Fax:
Practice Address - Street 1:150 ROUTE 37 W
Practice Address - Street 2:SUITE A-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8054
Practice Address - Country:US
Practice Address - Phone:732-244-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04387400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46328Medicare UPIN
NJBA003374Medicare ID - Type Unspecified