MEDICARE: BLAIRE FARRIOR HARROLD NP

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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	11009624	FL
2	207Q00000X	Family Medicine Physician	11009624	FL

General Provider Information

NPI Number	:	1760085062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIRE FARRIOR HARROLD NP

Provider Business Mailing Address
First Line	:	4616 W INGRAHAM ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-2120
Country	:	US
Telephone Number	:	813-470-9715
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3110
Country	:	US
Telephone Number	:	813-278-1012
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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