| NPI | 1417634668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILLIAN CASSANDRA JACKMAN Owner 813-940-4395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-06-29 |