Provider Demographics
NPI:1093804213
Name:FARNWORTH, CARLA RAE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:RAE
Last Name:FARNWORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-7675
Mailing Address - Country:US
Mailing Address - Phone:758-851-5207
Mailing Address - Fax:
Practice Address - Street 1:300 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-7675
Practice Address - Country:US
Practice Address - Phone:775-885-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001060363LA2100X
NVAPRN001060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAT192XMedicare PIN