Provider Demographics
NPI:1699788968
Name:GROOMS, BARBARA ANN (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:GROOMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100247
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0247
Mailing Address - Country:US
Mailing Address - Phone:352-273-6815
Mailing Address - Fax:352-273-7515
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2245
Practice Address - Country:US
Practice Address - Phone:352-273-6815
Practice Address - Fax:352-273-7515
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103777363A00000X
FLPAT9103777363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292840000Medicaid
FL117224700Medicaid
FLAC415SMedicare PIN