Healthcare Provider Details

I. General information

NPI: 1922328228
Provider Name (Legal Business Name): JACQUELINE E BARRETT MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SHERIDAN ST STE 450
HOLLYWOOD FL
33021-3415
US

IV. Provider business mailing address

4651 SHERIDAN ST STE 450
HOLLYWOOD FL
33021-3415
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-3355
  • Fax:
Mailing address:
  • Phone: 954-983-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME85154
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME85154
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME85154
License Number StateFL

VIII. Authorized Official

Name: DR. JACQUELINE E BARRETT
Title or Position: PRESIDENT
Credential: MD
Phone: 954-983-3355