| NPI | 1427440213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A NOWACKI Physician 727-347-4158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME60591) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2024-04-04 |