Provider Demographics
NPI:1518992908
Name:HOUSE CALLS OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:HOUSE CALLS OF CENTRAL FLORIDA LLC
Other - Org Name:HOUSE CALLS OF CENTRAL FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-433-0397
Mailing Address - Street 1:7 ORANGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-433-0397
Mailing Address - Fax:321-433-2660
Practice Address - Street 1:125 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 209 BOX 206
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952
Practice Address - Country:US
Practice Address - Phone:321-433-0397
Practice Address - Fax:321-433-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7896Medicare ID - Type UnspecifiedPROVIDER NUMBER