| NPI | 1376135889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA JACKSON Owner 786-290-5415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-02-05 |