| NPI | 1275178188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAISHA JOHNSON Nurse Practitioner 772-643-1645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2022-06-02 |