| NPI | 1396176103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LYNN GODDING Credentialer 727-485-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA3323) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2013-12-03 |