| NPI | 1306790019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATEEFAT TIWALADE ADELE Owner 813-494-4476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-02-21 |
| Last Update Date | 2026-02-21 |