1710162417 NPI number — MRS. FARAH ALI SERRANO CRNA

Table of content: MRS. FARAH ALI SERRANO CRNA (NPI 1710162417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710162417 NPI number — MRS. FARAH ALI SERRANO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO
Provider First Name:
FARAH
Provider Middle Name:
ALI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710162417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 N. HARRISON PARKWAY
Provider Second Line Business Mailing Address:
SUITE 200, MAILSTOP SH-9A
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-437-2672
Provider Business Mailing Address Fax Number:
954-851-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-798-8505
Provider Business Practice Location Address Fax Number:
561-798-8638
Provider Enumeration Date:
01/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN 9204735 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP 9204735 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP9204735 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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