Healthcare Provider Details

I. General information

NPI: 1699264663
Provider Name (Legal Business Name): FARAH LAZARRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NW 166TH ST STE 1
MIAMI FL
33169-6049
US

IV. Provider business mailing address

117 GOLF VILLAS CT NW
LAKE PLACID FL
33852-6657
US

V. Phone/Fax

Practice location:
  • Phone: 321-209-3211
  • Fax: 321-616-7638
Mailing address:
  • Phone: 305-433-1061
  • Fax: 321-616-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.002243-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179927
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9265181
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-LIC-156316
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberAPRN9265181
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1148949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: