| NPI | 1407042807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA CONCEICAO Office Manager 386-418-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 1557262) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-27 |