| NPI | 1396210993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH LARSON Practice Administrator 239-265-3391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| 364S00000X Clinical Nurse Specialist | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2021-09-03 |