Provider Demographics
NPI:1780114090
Name:POLING, FARRAH FAWN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:FAWN
Last Name:POLING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-694-9102
Mailing Address - Fax:239-694-9101
Practice Address - Street 1:6150 DIAMOND CENTRE CT UNIT 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4367
Practice Address - Country:US
Practice Address - Phone:239-561-9191
Practice Address - Fax:239-561-9188
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9360599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty