MEDICARE: MR. ROBERT BARRETT PA-C

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	PA9114777	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9114777	OTHER	FL	FLORIDA PHYSICIAN ASSISTANT LICENSE

General Provider Information

NPI Number	:	1235804477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT BARRETT PA-C

Provider Business Mailing Address
First Line	:	4211 W BOY SCOUT BLVD STE 400
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5766
Country	:	US
Telephone Number	:	813-443-2108
Fax Number	:	813-443-8255

Provider Business Practice Location Address
First Line	:	3902 MILLENIA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6407
Country	:	US
Telephone Number	:	407-449-8620
Fax Number	:	407-205-1686

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/15/2024

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Directions to “ MR. ROBERT BARRETT PA-C” Practice Location

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