| NPI | 1225899743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CLUKIE Administrator 813-997-2099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-01-22 |