| NPI | 1124885348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA ELLIS Authorized Official/Owner 904-252-3606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-09-10 |