Provider Demographics
NPI:1073583761
Name:EILEEN F. FARWICK, D.O.,P.A.
Entity Type:Organization
Organization Name:EILEEN F. FARWICK, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-296-1990
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:STE 386
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-296-1990
Mailing Address - Fax:407-296-1992
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 386
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-296-1990
Practice Address - Fax:407-296-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005926207V00000X
FLARNP 9297245363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45231OtherBLUE CROSS- GROUP#
FL45231Medicare ID - Type Unspecified