Provider Demographics
NPI:1699572131
Name:BARCO, JABAAR
Entity type:Individual
Prefix:
First Name:JABAAR
Middle Name:
Last Name:BARCO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6252 N BOUVIER ST # A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1430
Mailing Address - Country:US
Mailing Address - Phone:215-264-3666
Mailing Address - Fax:
Practice Address - Street 1:6252 N BOUVIER ST # A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1430
Practice Address - Country:US
Practice Address - Phone:215-264-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306322164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse