| NPI | 1457878654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA D WHITE President 904-544-3608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 3298772) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2020-10-22 |