Provider Demographics
NPI:1407025703
Name:FARMER, TERREASA LORRAINE (CRNA)
Entity Type:Individual
Prefix:
First Name:TERREASA
Middle Name:LORRAINE
Last Name:FARMER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402136
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2136
Mailing Address - Country:US
Mailing Address - Phone:910-997-2463
Mailing Address - Fax:910-997-4935
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:910-205-8245
Practice Address - Fax:910-205-8164
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNAN832Medicaid
SCNAN832Medicaid