| NPI | 1346001377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE HELM Provider Enrollment Account Manager 904-664-8068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-01-17 |