Provider Demographics
NPI:1063282499
Name:BARRY, ERICA NICOLE (LMT, RN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:BARRY
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13475 ATLANTIC BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3290
Mailing Address - Country:US
Mailing Address - Phone:904-263-6909
Mailing Address - Fax:
Practice Address - Street 1:10031 LOGAN FALLS CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2197
Practice Address - Country:US
Practice Address - Phone:904-263-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist