| NPI | 1245004472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE GORDON Owner/Provider 321-557-3065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2025-12-02 |