MEDICARE: HEATHER SHIMOJI BARKOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PAT9108034	FL
2	363A00000X	Physician Assistant	PA9108034	FL

General Provider Information

NPI Number	:	1023424223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SHIMOJI BARKOV

Provider Business Mailing Address
First Line	:	4226 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-3915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	08/14/2017

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Directions to “ HEATHER SHIMOJI BARKOV ” Practice Location

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