Provider Demographics
NPI:1811908486
Name:MOGER, BARBARA (CRNA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:MOGER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 LYNNDALE RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5201
Mailing Address - Country:US
Mailing Address - Phone:904-775-5280
Mailing Address - Fax:904-775-5281
Practice Address - Street 1:2416 LYNNDALE RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5201
Practice Address - Country:US
Practice Address - Phone:904-775-5280
Practice Address - Fax:904-775-5281
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010386367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ006311Medicare ID - Type Unspecified