Basic Information
| Provider Information | |||||||||
| NPI: | 1770575367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORKE | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 BIEDE AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | 4197844506 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 BIEDE AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | 4197844506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CTPE06517 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364S00000X | COA06517 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | CTPE06517 | 01 | OH | MEDICAL LIC | OTHER | 0939463 | 05 | OH | MEDICAID |