Provider Demographics
NPI:1285691550
Name:BARRETT, DELORIS G (ARNP)
Entity type:Individual
Prefix:
First Name:DELORIS
Middle Name:G
Last Name:BARRETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GERTRUDE
Other - Middle Name:DELORIS
Other - Last Name:BERNARD BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 HOLSONBACK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5114
Mailing Address - Country:US
Mailing Address - Phone:386-274-0790
Mailing Address - Fax:386-274-0800
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5114
Practice Address - Country:US
Practice Address - Phone:386-274-0790
Practice Address - Fax:386-274-0800
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1609182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033015900Medicaid
S81156Medicare UPIN
FL033015900Medicaid