| NPI | 1063434017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA MAYWALT Billing Manager 407-352-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME69749) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP2617642) |
| 363A00000X Physician Assistant (Licence: FL PA9103647) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-03-14 |