MEDICARE: MS. ERICA JANE FARR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	10091048-1206	UT

General Provider Information

NPI Number	:	1063965671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA JANE FARR PA-C

Provider Business Mailing Address
First Line	:	369 E 12TH AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2849
Country	:	US
Telephone Number	:	801-891-7923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 CIRCLE OF HOPE DR
Second Line	:	SUITE 2810
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5500
Country	:	US
Telephone Number	:	801-213-5688
Fax Number	:	801-585-0155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2016
Last Update Date	:	02/08/2023

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