| NPI | 1407320690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES TULLY Owner 904-725-6463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2023-10-05 |