Healthcare Provider Details

I. General information

NPI: 1235804477
Provider Name (Legal Business Name): ROBERT BARRETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 MILLENIA BLVD
ORLANDO FL
32839-6407
US

IV. Provider business mailing address

4211 W BOY SCOUT BLVD STE 400
TAMPA FL
33607-5766
US

V. Phone/Fax

Practice location:
  • Phone: 407-449-8620
  • Fax: 407-205-1686
Mailing address:
  • Phone: 813-443-2108
  • Fax: 813-443-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: