Provider Demographics
NPI:1730789744
Name:BARBOSA, POLYANA F (FNP)
Entity type:Individual
Prefix:
First Name:POLYANA
Middle Name:F
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MOUNT VERNON AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:339-293-2735
Mailing Address - Fax:
Practice Address - Street 1:491 MAPLE ST STE 208
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4025
Practice Address - Country:US
Practice Address - Phone:781-627-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily