Healthcare Provider Details

I. General information

NPI: 1932736238
Provider Name (Legal Business Name): ANASTASIA LYDIA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 SW WILLISTON RD
GAINESVILLE FL
32608-3928
US

IV. Provider business mailing address

3009 SW WILLISTON RD
GAINESVILLE FL
32608-3928
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5400
  • Fax:
Mailing address:
  • Phone: 352-294-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number166991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: