| NPI | 1215755277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAFAEL MATOS Provider 813-473-8373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2025-01-20 |