Provider Demographics
NPI:1962858225
Name:HAFIZI, HOMEYRA (RN)
Entity Type:Individual
Prefix:
First Name:HOMEYRA
Middle Name:
Last Name:HAFIZI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 VETERANS WAY
Mailing Address - Street 2:ORLANDO VETERANS AFFAIRS MEDICAL LAKE NONA CAMPUS
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-0000
Mailing Address - Country:US
Mailing Address - Phone:321-637-3616
Mailing Address - Fax:321-637-3602
Practice Address - Street 1:13800 VETERANS WAY
Practice Address - Street 2:ORLANDO VETERANS AFFAIRS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:321-637-3616
Practice Address - Fax:321-637-3602
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2602952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse