MEDICARE: LINA BARAKAT

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
1	133V00000X	Registered Dietitian	5418	OH
2	363LF0000X	Family Nurse Practitioner	COA.17993-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5418	OTHER	OH	OHIO BOARD
2	RN.395169-1	OTHER	OH	OHIO BOARD OF NURSING
3	COA.17993-NP	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1912123902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINA BARAKAT

Provider Business Mailing Address
First Line	:	4925 JACKMAN RD
Second Line	:	THE LITTLE CLINIC
City	:	TOLEDO
State	:	OH
Zip	:	43613-3574
Country	:	US
Telephone Number	:	419-473-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	4925 JACKMAN RD
Second Line	:	THE LITTLE CLINIC
City	:	TOLEDO
State	:	OH
Zip	:	43613-3574
Country	:	US
Telephone Number	:	419-473-1715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	11/10/2016

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Directions to “ LINA BARAKAT ” Practice Location

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