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General NPI Number Information
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NPI Number | 1730481326
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Entity Type | Organization
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Legal Business Name | IN HOME PRIMARY CARE PROVIDER, LLC
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 5545 MARIE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1913
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Country | US
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Telephone | 813-406-1925
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Fax |
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Provider Business Mailing Address
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Address Line | 5545 MARIE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1913
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Country | US
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Telephone | 813-406-1925
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRIS C BRACKEN
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Credential | NP
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Telephone | 813-406-1925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2078202
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License Number State | FL
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