1235102260 NPI number — DR. NEYSA L BARTLETT D.O.

Table of content: DR. NEYSA L BARTLETT D.O. (NPI 1235102260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235102260 NPI number — DR. NEYSA L BARTLETT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTLETT
Provider First Name:
NEYSA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235102260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3718-3722 AVALON PARK EAST BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32828-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-518-1074
Provider Business Mailing Address Fax Number:
407-518-9056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3718-3722 AVALON PARK EAST BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32828-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-518-1074
Provider Business Practice Location Address Fax Number:
407-518-9056
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS17292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4390871 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5791690 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P95391 . This is a "BLUE CHOICE & BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5130061 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 109431300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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