| NPI | 1083481824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC MOORE Owner 407-732-7957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |