Healthcare Provider Details

I. General information

NPI: 1063404457
Provider Name (Legal Business Name): FARRUKH AMBAREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 NW 11TH PL STE A
GAINESVILLE FL
32605-3141
US

IV. Provider business mailing address

7109 NW 11TH PLACE SUITE A
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2890
  • Fax: 352-331-2915
Mailing address:
  • Phone: 352-331-2890
  • Fax: 352-331-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301074916
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301074916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: