| NPI | 1114460227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETT ELAINE EDWARDS Provider 941-900-2701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 171100000X Acupuncturist |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2017-05-30 |