| NPI | 1164130613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTA K DAVIS Owner 727-741-8475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2023-09-25 |