Healthcare Provider Details

I. General information

NPI: 1235902149
Provider Name (Legal Business Name): ASHLEY TAYLOR FARHAT-TOMASZEWSKI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E JEFFERSON AVE STE 100
DETROIT MI
48207-4489
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-1618
  • Fax:
Mailing address:
  • Phone: 138-744-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704342735
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: