| NPI | 1194392019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY HOBACK CEO 813-866-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-07-30 |