Provider Demographics
NPI:1073776365
Name:FLORA, FARZANA AL NUR (PA)
Entity Type:Individual
Prefix:MISS
First Name:FARZANA
Middle Name:AL NUR
Last Name:FLORA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15011 86TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3307
Mailing Address - Country:US
Mailing Address - Phone:718-291-2728
Mailing Address - Fax:
Practice Address - Street 1:15011 86TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3307
Practice Address - Country:US
Practice Address - Phone:718-291-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012596363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical