| NPI | 1265915359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD R KOP Director Of Operations 352-362-0627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2020-11-05 |