| NPI | 1023609740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE GRAY Credentialing Specialist 352-678-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2024-01-26 |