| NPI | 1205174695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH W. CARLSON Owner 904-619-2703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME88018) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9278608) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2013-01-21 |