Provider Demographics
NPI:1134857683
Name:EDEN MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:EDEN MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-545-6441
Mailing Address - Street 1:4726 BLOODHOUND ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8735
Mailing Address - Country:US
Mailing Address - Phone:407-545-6441
Mailing Address - Fax:407-545-6421
Practice Address - Street 1:2295 S HIAWASSEE RD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8748
Practice Address - Country:US
Practice Address - Phone:407-545-6441
Practice Address - Fax:407-545-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty