Provider Demographics
NPI:1003828906
Name:FARMER, TERRI LEA
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEA
Last Name:FARMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 LOVETT AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2409
Mailing Address - Country:US
Mailing Address - Phone:321-269-8104
Mailing Address - Fax:321-269-8104
Practice Address - Street 1:4915 CARODOC CIR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1472
Practice Address - Country:US
Practice Address - Phone:321-267-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion