Provider Demographics
NPI:1598138695
Name:FARRELL, CRISTINA (PNP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALL POINTS DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1302
Mailing Address - Country:US
Mailing Address - Phone:631-648-8421
Mailing Address - Fax:
Practice Address - Street 1:8 ALL POINTS DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1302
Practice Address - Country:US
Practice Address - Phone:631-648-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382498363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics