Healthcare Provider Details

I. General information

NPI: 1235672411
Provider Name (Legal Business Name): MRS. FARA BACCHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FARA BACCHUS ARNP

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 W CENTRAL BLVD
ORLANDO FL
32805-1809
US

IV. Provider business mailing address

464 GOLDENMOSS LOOP
OCOEE FL
34761-4781
US

V. Phone/Fax

Practice location:
  • Phone: 407-858-1400
  • Fax:
Mailing address:
  • Phone: 407-963-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberARNP 3036332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: