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General NPI Number Information
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NPI Number | 1396483277
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Entity Type | Individual
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Provider Name | EBONY TANAE FARRIS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/22/2022
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 6000 W HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-5105
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Country | US
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Telephone | 850-452-5638
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 AUGUSTA DR
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City | MARRERO
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State | LA
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Zip | 70072-6811
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Country | US
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Telephone | 504-450-3647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 208555
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License Number State | LA
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