Healthcare Provider Details

I. General information

NPI: 1033006283
Provider Name (Legal Business Name): BARN TO BEACH HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4296 5TH AVE
MARIANNA FL
32446-2173
US

IV. Provider business mailing address

4296 5TH AVE
MARIANNA FL
32446-2173
US

V. Phone/Fax

Practice location:
  • Phone: 850-557-8727
  • Fax:
Mailing address:
  • Phone: 850-557-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN FENTON
Title or Position: OWNER
Credential: APRN
Phone: 850-557-8727