Basic Information
| Provider Information | |||||||||
| NPI: | 1154051571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 BARBARA CIR | ||||||||
| Address2: | |||||||||
| City: | MACCLENNY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320635575 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14540 OLD SAINT AUGUSTINE RD STE 2207 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322587419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046520800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0100X | 9399691 | FL | N | Nursing Service Providers | Registered Nurse | Gastroenterology | 363LF0000X | 11020006 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.