| NPI | 1033802848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARNISHA LATASHA FITZGERALD Owner 443-763-7154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2024-05-16 |