Individual
MRS. PENNY LOU PHARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6210 HARMONY LN, YANKEETOWN, FL 34498-2369
(352) 447-1775
(352) 447-2165
Mailing address
14 HICKORY AVE, YANKEETOWN, FL 34498-2424
(352) 447-1775
(352) 447-2165
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
ARNP1239672
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474927
VALUE OPTIONS PROVIDER NU
FL
Enumeration date
12/28/2006
Last updated
07/09/2007
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