Provider Demographics
NPI:1275061426
Name:FARRIDE, MIMI MYRLANDE
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:MYRLANDE
Last Name:FARRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 PINEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6176
Mailing Address - Country:US
Mailing Address - Phone:561-714-6616
Mailing Address - Fax:
Practice Address - Street 1:9243 PINEVILLE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6176
Practice Address - Country:US
Practice Address - Phone:561-714-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9196724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner