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Individual

MRS. FARA BACCHUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
832 W CENTRAL BLVD, ORLANDO, FL 32805-1809
(407) 858-1400
Mailing address
464 GOLDENMOSS LOOP, OCOEE, FL 34761-4781
(407) 963-7693

Taxonomy

Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
ARNP 3036332
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020035000
FL
Enumeration date
11/21/2016
Last updated
12/20/2017
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