| NPI | 1275074692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA BETH HEARN Owner 772-332-2635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP2827802) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2017-05-12 |