Basic Information
Provider Information | |||||||||
NPI: | 1396015459 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARMER | ||||||||
FirstName: | AMBER | ||||||||
MiddleName: | LEAH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RAINEY | ||||||||
OtherFirstName: | AMBER | ||||||||
OtherMiddleName: | LEAH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | C.N.A. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 864074 | ||||||||
Address2: | HALIFAX HEALTHCARE SYSTEMS, INC. | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328864074 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3862264590 | ||||||||
FaxNumber: | 3862263371 | ||||||||
Practice Location | |||||||||
Address1: | 303 NO. CLYDE MORRIS BLVD. | ||||||||
Address2: | HALIFAX MEDICAL CENTER | ||||||||
City: | DAYTONA BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 321142709 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3864252285 | ||||||||
FaxNumber: | 3864257522 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/06/2012 | ||||||||
LastUpdateDate: | 01/06/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9106308 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.