| NPI | 1174128300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA OLIVER Manager 904-643-7532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2020-12-04 |