Healthcare Provider Details

I. General information

NPI: 1174968226
Provider Name (Legal Business Name): AMANDA MARIE FARINA MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MEDICAL ARTS PAVILION 2, SUITE 3302
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD MEDICAL ARTS PAVILION 2, SUITE 3302
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4144
  • Fax: 302-623-4147
Mailing address:
  • Phone: 302-623-4144
  • Fax: 302-623-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000654
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: