Provider Demographics
NPI:1245827328
Name:BAC HOUSE CALLS ADULT & FAMILY HEALTH
Entity type:Organization
Organization Name:BAC HOUSE CALLS ADULT & FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIRGET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORDIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-863-6389
Mailing Address - Street 1:2501 MARSHFIELD PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2272
Mailing Address - Country:US
Mailing Address - Phone:407-863-6389
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR # 3367
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:407-863-6389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty