| NPI | 1285391144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE KELLY SMITH Operator 863-268-7990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-11-25 |
| Last Update Date | 2023-05-19 |