Provider Demographics
NPI:1346417813
Name:FARNELL, CLAIRE WIETESKA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:WIETESKA
Last Name:FARNELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4630
Mailing Address - Country:US
Mailing Address - Phone:727-767-8181
Mailing Address - Fax:727-767-8030
Practice Address - Street 1:501 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4630
Practice Address - Country:US
Practice Address - Phone:727-767-8181
Practice Address - Fax:727-767-8030
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1856862363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY139WOtherBLUE CROSS BLUE SHIELD
FL000956000Medicaid