| NPI | 1124751821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA VALLEE Practice Manager 407-212-7113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 163W00000X Registered Nurse | |
| 207QS0010X Family Medicine Sports Medicine | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LP2300X Nurse Practitioner Primary Care | |
| 363LW0102X Nurse Practitioner Women's Health | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2024-06-27 |