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General NPI Number Information
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NPI Number | 1891122552
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Entity Type | Organization
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Legal Business Name | JANICE D BACCHUS, LLC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 9000 SW 152ND ST SUITE 105
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1981
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Country | US
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Telephone | 786-445-0810
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Fax | 786-217-1409
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Provider Business Mailing Address
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Address Line | 9000 SW 152ND ST SUITE 105
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1981
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Country | US
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Telephone | 786-445-0810
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Fax | 786-217-1409
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Authorized Official
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Title or Position | OWNER
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Name | MISS JANICE DENISE BACCHUS
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Credential | ARNP
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Telephone | 786-423-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9185531
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License Number State | FL
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