| NPI | 1063979730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE DE LA GARDELLE VP Operations 813-277-4571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2024-08-16 |