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General NPI Number Information
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NPI Number | 1326919291
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Entity Type | Organization
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Legal Business Name | ETERNAL ESSENCE NP LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 12730 COMMONWEALTH DR STE 6
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City | FORT MYERS
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State | FL
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Zip | 33913-8079
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Country | US
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Telephone | 941-218-0479
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Fax | 239-227-2079
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Provider Business Mailing Address
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Address Line | 11203 SAND PINE CT
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City | FORT MYERS
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State | FL
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Zip | 33913-8814
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Country | US
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Telephone | 239-227-2079
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Fax | 239-227-2079
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Authorized Official
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Title or Position | OWNER
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Name | JASON FARAH
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Credential | ARNP
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Telephone | 941-218-0479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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