Provider Demographics
NPI:1134017007
Name:FARRELL-DREW, JENIKA
Entity type:Individual
Prefix:
First Name:JENIKA
Middle Name:
Last Name:FARRELL-DREW
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 1:132 GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4228
Mailing Address - Country:US
Mailing Address - Phone:646-244-6439
Mailing Address - Fax:
Practice Address - Street 1:428 RIO GRANDE CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4633
Practice Address - Country:US
Practice Address - Phone:646-244-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351113363LF0000X
FL11035724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily