| NPI | 1023681558 |
|---|---|
| Other Name | JACKSON STREET PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | LYNDA GORKEN VP 727-281-9202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2021-07-22 |