MEDICARE: MRS. FARRAH FAWN POLING ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ARNP9360599	FL

General Provider Information

NPI Number	:	1780114090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FARRAH FAWN POLING ARNP

Provider Business Mailing Address
First Line	:	8140 COLLEGE PKWY STE 202
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5169
Country	:	US
Telephone Number	:	239-645-6400
Fax Number	:	239-245-7981

Provider Business Practice Location Address
First Line	:	8140 COLLEGE PKWY STE 202
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5169
Country	:	US
Telephone Number	:	239-645-6400
Fax Number	:	239-245-2022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	02/20/2026

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