| NPI | 1164169371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LUCILLE RANDOLPH Nurse Practitioner 863-333-0032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2024-04-22 |