Provider Demographics
NPI:1386261907
Name:FARNSWORTH, NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 N 68TH ST UNIT 215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6868
Mailing Address - Country:US
Mailing Address - Phone:602-904-0500
Mailing Address - Fax:
Practice Address - Street 1:2935 N 68TH ST UNIT 215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6868
Practice Address - Country:US
Practice Address - Phone:602-904-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06202542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily