Provider Demographics
NPI:1386856326
Name:DEMBEK, BARBARA (CNM)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DEMBEK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3703
Mailing Address - Country:US
Mailing Address - Phone:904-819-1500
Mailing Address - Fax:904-810-1023
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 3002
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3703
Practice Address - Country:US
Practice Address - Phone:904-819-1500
Practice Address - Fax:904-810-1023
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2247762367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301990000Medicaid
FLY6726YMedicare ID - Type Unspecified