Provider Demographics
NPI:1992426506
Name:MIRZA, FARRAH (NP)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2741
Mailing Address - Country:US
Mailing Address - Phone:713-800-0660
Mailing Address - Fax:713-827-1380
Practice Address - Street 1:2130 W HOLCOMBE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3308
Practice Address - Country:US
Practice Address - Phone:713-800-0660
Practice Address - Fax:713-600-0070
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093549363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care