Provider Demographics
NPI:1841677382
Name:FARNER, JO ELLEN (CRNP)
Entity type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:
Last Name:FARNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-0515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 COLONIAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4899
Practice Address - Country:US
Practice Address - Phone:717-381-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2022-06-23
Deactivation Date:2019-04-02
Deactivation Code:
Reactivation Date:2019-04-17
Provider Licenses
StateLicense IDTaxonomies
PASP014951363LF0000X, 363LF0000X
GARN285949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411587Medicare PIN