Healthcare Provider Details

I. General information

NPI: 1174863351
Provider Name (Legal Business Name): BARBARA A VIOLETTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA A TACKETT APRN

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 TECHSTER BLVD STE 1
FORT MYERS FL
33966-4805
US

IV. Provider business mailing address

3191 HARBOR BLVD STE A
PORT CHARLOTTE FL
33952-6755
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-2751
  • Fax:
Mailing address:
  • Phone: 941-883-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30598
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18213
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number263814
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9453346
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9453346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: