Provider Demographics
NPI:1881875102
Name:BARRETT, ELLIS PARKER
Entity type:Individual
Prefix:MR
First Name:ELLIS
Middle Name:PARKER
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14175 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-3223
Mailing Address - Country:US
Mailing Address - Phone:352-625-1001
Mailing Address - Fax:352-625-1001
Practice Address - Street 1:14175 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-3223
Practice Address - Country:US
Practice Address - Phone:352-625-1001
Practice Address - Fax:352-625-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8261146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic