| NPI | 1437763125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN ROBERSON President 386-405-2823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |