| NPI | 1083457345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA MARIE JOHNSON Owner 352-572-0428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-08-27 |