| NPI | 1457093072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NACRESHA NICOLE RICHARDSON President 863-288-1709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2024-02-01 |