| NPI | 1184203721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY P CASSIDY Owner 386-438-5722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2023-07-17 |