| NPI | 1386365476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY BOULDIN CEO 321-989-2187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 246Z00000X Specialist/Technologist, Other | |
| 251J00000X Nursing Care | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 261QR1100X Clinic/Center Research | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2023-07-26 |