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NPI Code Detail

MEDICARE: MRS. MONEAH SAMANTHA BARRACKS APN

MEDICARE:  MRS. MONEAH SAMANTHA BARRACKS  APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerF306978-1NY
2363LA2200XAdult Health Nurse Practitioner26NJ00507700NJ
3363LG0600XGerontology Nurse Practitioner26NJ00507700NJ
4363LA2200XAdult Health Nurse PractitionerSP017568PA

General Provider Information

NPI Number : 1265841209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MONEAH SAMANTHA BARRACKS APN
Provider Business Mailing Address
First Line : 3200 BENSALEM BLVD
Second Line :
City : BENSALEM
State : PA
Zip : 19020-1956
Country : US
Telephone Number : 215-752-2370
Fax Number :
Provider Business Practice Location Address
First Line : 1149 MYRTLE AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-6007
Country : US
Telephone Number : 718-574-1928
Fax Number : 718-919-2374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2014
Last Update Date : 09/29/2020

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