Provider Demographics
NPI:1720257629
Name:NANCY R. BARRETT MD, LLC
Entity Type:Organization
Organization Name:NANCY R. BARRETT MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-978-0339
Mailing Address - Street 1:1715 37TH PL
Mailing Address - Street 2:3RD FL.
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4502
Mailing Address - Country:US
Mailing Address - Phone:772-978-0339
Mailing Address - Fax:
Practice Address - Street 1:1715 37TH PL
Practice Address - Street 2:3RD FL.
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4502
Practice Address - Country:US
Practice Address - Phone:772-978-0339
Practice Address - Fax:772-978-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2739003Medicaid
FLH89191Medicare UPIN