| NPI | 1376564476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON LYNN FREDERICKS Administrator 941-923-5861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 0079271) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |