Provider Demographics
NPI:1023440260
Name:FARMER, MILDRED VERONICA (MD)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:VERONICA
Last Name:FARMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N SHORE DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4836
Mailing Address - Country:US
Mailing Address - Phone:727-560-2323
Mailing Address - Fax:
Practice Address - Street 1:16176 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8910
Practice Address - Country:US
Practice Address - Phone:352-597-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048792207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578777694OtherNPI
FL1578777694OtherNPI