Healthcare Provider Details

I. General information

NPI: 1104059666
Provider Name (Legal Business Name): JOAN M FARMER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN M WAGSTAFF

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W STATE ROAD 434 SUITE 101
LONGWOOD FL
32750-4984
US

IV. Provider business mailing address

PO BOX 520879
LONGWOOD FL
32752-0879
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-5437
  • Fax: 407-830-4907
Mailing address:
  • Phone: 407-830-5437
  • Fax: 407-830-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1482452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: