Provider Demographics
NPI:1992979777
Name:PHARR, LA QUENDA MOSBY
Entity type:Individual
Prefix:
First Name:LA QUENDA
Middle Name:MOSBY
Last Name:PHARR
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 1:10361 SHELBY CREEK RD.S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221
Mailing Address - Country:US
Mailing Address - Phone:904-378-9910
Mailing Address - Fax:
Practice Address - Street 1:10361 SHELBY CREEK RD.S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221
Practice Address - Country:US
Practice Address - Phone:904-378-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker