Healthcare Provider Details

I. General information

NPI: 1992242911
Provider Name (Legal Business Name): ANIKA FAROUQ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EAST BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

P.O BOX 4749
MEDFORD OR
97501-0227
US

V. Phone/Fax

Practice location:
  • Phone: 817-983-9901
  • Fax:
Mailing address:
  • Phone: 541-789-7000
  • Fax: 541-789-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132606
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201702146NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: