Provider Demographics
NPI:1629100656
Name:FARLEY, THOMAS L (NP MSN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:FARLEY
Suffix:
Gender:M
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE M917
Mailing Address - Street 2:BOX 0624
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0624
Mailing Address - Country:US
Mailing Address - Phone:415-353-1847
Mailing Address - Fax:415-353-1990
Practice Address - Street 1:505 PARNASSUS AVE M917
Practice Address - Street 2:BOX 0624
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0624
Practice Address - Country:US
Practice Address - Phone:415-353-1847
Practice Address - Fax:415-353-1990
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN569767163WM0705X
CANPF14209363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
089615OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
089615OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER