| NPI | 1285380642 |
|---|---|
| Doing Business As | PEACE RIVER CENTER |
| Entity Type | Organization |
| Authorized Contact | JO DECK Credentialing Specialist 863-519-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-24 |