| NPI | 1114647641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA MERRITT Senior Manager, Credentialing 813-596-5726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2024-01-15 |