Provider Demographics
NPI:1932792835
Name:CARDONA, FARRAH FAYE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:FAYE
Last Name:CARDONA
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 1:15333 PEACH BLOOM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3906
Mailing Address - Country:US
Mailing Address - Phone:727-364-4091
Mailing Address - Fax:
Practice Address - Street 1:15333 PEACH BLOOM RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34614-3906
Practice Address - Country:US
Practice Address - Phone:727-364-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9372194163WC0200X
FLAPRN11012584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine