Provider Demographics
NPI:1174008205
Name:FARFAL, CAROLINA FERNANDA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:FERNANDA
Last Name:FARFAL
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 1:1035 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4502
Mailing Address - Country:US
Mailing Address - Phone:801-836-2078
Mailing Address - Fax:
Practice Address - Street 1:410 PENNINGTON DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-7596
Practice Address - Country:US
Practice Address - Phone:214-385-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX755240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse