| NPI | 1336819788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE SMITH Owner 863-455-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2021-09-23 |