| NPI | 1205441615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA IMARI WASHINGTON Nurse Practitioner 904-505-7566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2021-03-19 |