| NPI | 1033880232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE R HARGROVE Provider/Authorized Member 904-872-4245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2023-11-04 |