Healthcare Provider Details

I. General information

NPI: 1619601747
Provider Name (Legal Business Name): PAUL BARRETT RN MSN MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL BARRETT RN MSN MBA

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N 31ST CT
HOLLYWOOD FL
33021-6112
US

IV. Provider business mailing address

802 N 31ST CT
HOLLYWOOD FL
33021-6112
US

V. Phone/Fax

Practice location:
  • Phone: 786-575-7665
  • Fax:
Mailing address:
  • Phone: 786-575-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN1810582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: