| NPI | 1043710288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MICHELLE BANUELOS Nurse Practitioner 850-983-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-02-14 |