Provider Demographics
NPI:1700559895
Name:FARNICK, ERICA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FARNICK
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23794 COPPERWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8265
Mailing Address - Country:US
Mailing Address - Phone:248-660-3766
Mailing Address - Fax:
Practice Address - Street 1:23794 COPPERWOOD DR W
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8265
Practice Address - Country:US
Practice Address - Phone:248-660-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275743363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner