Provider Demographics
NPI:1386269017
Name:ZOLFAGHARI, FAITH SELECT
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:SELECT
Last Name:ZOLFAGHARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-269-8986
Practice Address - Street 1:1120 STATE ROAD 436 STE 1600
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6182
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-269-8986
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9365224163W00000X
FL11007314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse