Basic Information
Provider Information
NPI: 1720689821
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARKER
FirstName: STEVEN
MiddleName: MICHAEL
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14690 SPRING HILL DR STE 305
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346098102
CountryCode: US
TelephoneNumber: 3522775348
FaxNumber: 3526062857
Practice Location
Address1: 5350 SPRING HILL DR
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346064562
CountryCode: US
TelephoneNumber: 3526888116
FaxNumber: 3526869477
Other Information
ProviderEnumerationDate: 11/04/2020
LastUpdateDate: 08/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11010042FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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