| NPI | 1023695988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABIOLA B MARCELIN Owner, CEO 904-337-1268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 171W00000X Contractor | |
| 202C00000X Independent Medical Examiner | |
| 207R00000X Internal Medicine | |
| 261Q00000X Clinic/Center | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic | |
| 291U00000X Clinical Medical Laboratory | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2024-09-13 |