Provider Demographics
NPI:1750781480
Name:NYCE REESOR, BARBARA (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:NYCE REESOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3505
Mailing Address - Country:US
Mailing Address - Phone:863-983-2282
Mailing Address - Fax:863-983-2864
Practice Address - Street 1:115 S GLORIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3505
Practice Address - Country:US
Practice Address - Phone:863-983-2282
Practice Address - Fax:863-983-2864
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108107363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108107OtherFL LICENSE NUMBER