| NPI | 1386247310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASIE RUSSELL Owner 813-444-7311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 208D00000X General Practice |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2023-03-07 |