| NPI | 1073089488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA MERRITT Senior Manager, Credentialing 813-596-5726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-04-29 |