Provider Demographics
NPI:1073865804
Name:WARF, SERENA (PA)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:WARF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:HAFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:086-255-0842
Mailing Address - Fax:
Practice Address - Street 1:632 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2278
Practice Address - Country:US
Practice Address - Phone:239-343-3800
Practice Address - Fax:239-343-3993
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9106751363A00000X
FLPA9106751363A00000X
IDPA-2726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006736700Medicaid