NPI | 1013584317 |
---|---|
Entity Type | Organization |
Authorized Contact | SHERRY HOBACK CEO 813-866-0930 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 208D00000X General Practice |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2021-06-07 |
Last Update Date | 2024-12-02 |