Provider Demographics
NPI:1750845152
Name:GHAFFAR, FAISAL MOHAMMED (APRN)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:MOHAMMED
Last Name:GHAFFAR
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 NW 73RD ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3023
Mailing Address - Country:US
Mailing Address - Phone:305-978-0148
Mailing Address - Fax:
Practice Address - Street 1:8050 N UNIVERSITY DR STE 201
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2102
Practice Address - Country:US
Practice Address - Phone:954-240-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11001212OtherBOARD OF NURSING (APRN)