Provider Demographics
NPI:1275930380
Name:FARRAR, MINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:
Last Name:FARRAR
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 1:139 FOX RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3472
Mailing Address - Country:US
Mailing Address - Phone:865-769-9595
Mailing Address - Fax:865-769-9510
Practice Address - Street 1:139 FOX RD SUITE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924
Practice Address - Country:US
Practice Address - Phone:865-769-9595
Practice Address - Fax:865-769-9510
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily