Provider Demographics
NPI:1497342414
Name:EXTRA-PHANOR, FARLAH (RN)
Entity Type:Individual
Prefix:
First Name:FARLAH
Middle Name:
Last Name:EXTRA-PHANOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FARLAH
Other - Middle Name:
Other - Last Name:EXTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1031 NE 138TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 NE 138TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3823
Practice Address - Country:US
Practice Address - Phone:305-600-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9500701163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health