| NPI | 1396920500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL BLOOMQUIST MIKULKA Medical Doctor 407-645-3777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL ME0050632) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2023-04-10 |