| NPI | 1215802749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOSAGHARE OWENS Owner 813-800-6337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-12-02 |