| NPI | 1174719082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH M SUTPHIN Billing Manager 407-829-8960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL me88467, me88578) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP1103432) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2009-07-07 |