Provider Demographics
NPI:1992434377
Name:FARMER, CHARLES B II (LPN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:FARMER
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E CHURCH AVE # 55
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-9762
Mailing Address - Country:US
Mailing Address - Phone:731-267-6861
Mailing Address - Fax:
Practice Address - Street 1:3939 EASTGATE CT
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-7236
Practice Address - Country:US
Practice Address - Phone:239-543-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000040736253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPN0000040736OtherSTATE ISSUED