| NPI | 1184352114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERONICA DISQUE Credentialing Manager 813-866-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2023-02-07 |