Provider Demographics
NPI:1730481326
Name:IN HOME PRIMARY CARE PROVIDER, LLC
Entity type:Organization
Organization Name:IN HOME PRIMARY CARE PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:813-406-1925
Mailing Address - Street 1:5545 MARIE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1913
Mailing Address - Country:US
Mailing Address - Phone:813-406-1925
Mailing Address - Fax:
Practice Address - Street 1:5545 MARIE DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1913
Practice Address - Country:US
Practice Address - Phone:813-406-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2078202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty