Provider Demographics
NPI:1639354822
Name:FARRAH, JEFFREY JOHN (DC, APRN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:FARRAH
Suffix:
Gender:M
Credentials:DC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-2301
Mailing Address - Country:US
Mailing Address - Phone:850-386-8282
Mailing Address - Fax:
Practice Address - Street 1:2425 MAHAN DR STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-2301
Practice Address - Country:US
Practice Address - Phone:850-386-8282
Practice Address - Fax:850-386-7184
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9462111N00000X
FLAPRN11004162363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No111N00000XChiropractic ProvidersChiropractor