| NPI | 1124690433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA MARIE PREBECK VP Of Operations 727-559-9461 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |