Provider Demographics
NPI:1942188602
Name:FARMER, TIARA SHANAY (FNP)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:SHANAY
Last Name:FARMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4627
Mailing Address - Country:US
Mailing Address - Phone:856-383-1494
Mailing Address - Fax:
Practice Address - Street 1:140 PAWNEE AVE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4627
Practice Address - Country:US
Practice Address - Phone:856-383-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15385400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner