Provider Demographics
NPI:1467211102
Name:FAHMIDA, HOMAYRA (APRN)
Entity Type:Individual
Prefix:
First Name:HOMAYRA
Middle Name:
Last Name:FAHMIDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3964
Mailing Address - Country:US
Mailing Address - Phone:386-450-0597
Mailing Address - Fax:
Practice Address - Street 1:949 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3964
Practice Address - Country:US
Practice Address - Phone:386-450-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily