| NPI | 1013269802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA LYNN SCANLAN Provider Enrollment Director 954-377-2954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2025-07-21 |