| NPI | 1366836355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE LAWSON Director Of Clinical Services 813-549-2134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2015-03-27 |