=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154781888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN BARTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2016
-----------------------------------------------------
Last Update Date | 02/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3157 N ALAFAYA TRL
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-2940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-215-0095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3928 TANGLEWOOD CIR
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32780-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-432-9716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | IMH 14030
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------