| NPI | 1174945190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LOCKHART Administrator 352-732-9643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME42777) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA2229) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2019-03-25 |