Provider Demographics
NPI:1104059666
Name:FARMER, JOAN M (ARNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:FARMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:WAGSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 520879
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-0879
Mailing Address - Country:US
Mailing Address - Phone:407-830-5437
Mailing Address - Fax:407-830-4907
Practice Address - Street 1:521 W STATE ROAD 434
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4984
Practice Address - Country:US
Practice Address - Phone:407-830-5437
Practice Address - Fax:407-830-4907
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1482452363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics