Provider Demographics
NPI:1932433620
Name:BARNETT, TJ (PA-C)
Entity Type:Individual
Prefix:
First Name:TJ
Middle Name:
Last Name:BARNETT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S GILBERT RD STE 109
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1594
Mailing Address - Country:US
Mailing Address - Phone:480-899-4333
Mailing Address - Fax:480-899-7219
Practice Address - Street 1:2450 S GILBERT RD STE 109
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1594
Practice Address - Country:US
Practice Address - Phone:480-899-4333
Practice Address - Fax:480-899-7219
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5380363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ814422Medicaid
AZ5380OtherARIZONA MEDICAL LICENSE