Basic Information
Provider Information
NPI: 1396063780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FARMER
FirstName: ADA
MiddleName: MARIA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 770 NORTHPOINT PARKWAY
Address2: SUITE 102
City: WEST PALM BEACH
State: FL
PostalCode: 33407
CountryCode: US
TelephoneNumber: 5612757604
FaxNumber: 5618025385
Practice Location
Address1: 770 NORTHPOINT PKWY
Address2: SUITE 200
City: WEST PALM BEACH
State: FL
PostalCode: 334071901
CountryCode: US
TelephoneNumber: 5616553331
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2010
LastUpdateDate: 09/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X FLN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000XME118126FLY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
01262410005FL MEDICAID


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