Provider Demographics
NPI:1477619377
Name:PHARES, PENNY LOU (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LOU
Last Name:PHARES
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 1:14 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKEETOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34498-2424
Mailing Address - Country:US
Mailing Address - Phone:352-447-1775
Mailing Address - Fax:352-447-2165
Practice Address - Street 1:6210 HARMONY LN
Practice Address - Street 2:
Practice Address - City:YANKEETOWN
Practice Address - State:FL
Practice Address - Zip Code:34498-2369
Practice Address - Country:US
Practice Address - Phone:352-447-1775
Practice Address - Fax:352-447-2165
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1239672163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL474927OtherVALUE OPTIONS PROVIDER NU