Healthcare Provider Details

I. General information

NPI: 1104395144
Provider Name (Legal Business Name): COLBY JOEL BARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 E SILVER SPRINGS BLVD
OCALA FL
34470-6405
US

IV. Provider business mailing address

PO BOX 2066
LECANTO FL
34460-2066
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-7336
  • Fax:
Mailing address:
  • Phone: 352-563-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: