| NPI | 1013712827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI LEEBERG Owner 321-249-2677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 2084P0805X |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-02-17 |